Provider Demographics
NPI:1003857434
Name:VALLEY VITA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:VALLEY VITA MEDICAL CENTER, INC
Other - Org Name:TARZANA VALLEY VITA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:YUZEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GUROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-910-0333
Mailing Address - Street 1:18607 VENTURA BLVD.,
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4144
Mailing Address - Country:US
Mailing Address - Phone:818-758-8282
Mailing Address - Fax:818-758-8286
Practice Address - Street 1:18607 VENTURA BLVD.,
Practice Address - Street 2:SUITE 206
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4144
Practice Address - Country:US
Practice Address - Phone:818-758-8282
Practice Address - Fax:818-758-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090900Medicaid
CAZZZ02527ZOtherBLUE SHIELD
CAW15251Medicare PIN
CAZZZ02527ZOtherBLUE SHIELD