1437474145 NPI number — MED VALLEY, INC.

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 1437474145 NPI number — MED VALLEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED VALLEY, INC.
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:
1437474145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17915 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-345-5903
Provider Business Mailing Address Fax Number:
818-345-5908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17915 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91316-3630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-345-5903
Provider Business Practice Location Address Fax Number:
818-345-5908
Provider Enumeration Date:
04/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KARAPETYAN
Authorized Official First Name:
KARINE
Authorized Official Middle Name:
KARLENI
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
818-345-5903

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2008 , 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)





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