1336471135 NPI number — MOLANI MEDICAL GROUP A PROFESSIONAL MEDICAL CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336471135 NPI number — MOLANI MEDICAL GROUP A PROFESSIONAL MEDICAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOLANI MEDICAL GROUP A PROFESSIONAL MEDICAL CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336471135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20801 SARDINIA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTER RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91326-4432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-998-1578
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4955 VAN NUYS BLVD
Provider Second Line Business Practice Location Address:
#415
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91403-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-528-1080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOLANI
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
ANWAR
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
818-528-1080

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  C53899 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: C53794 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1336471135 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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