Provider Demographics
NPI:1073733630
Name:VILONA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:VILONA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-487-9100
Mailing Address - Street 1:PO BOX 55901
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-0901
Mailing Address - Country:US
Mailing Address - Phone:818-487-9100
Mailing Address - Fax:818-487-9111
Practice Address - Street 1:12103 VENTURA PL
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2605
Practice Address - Country:US
Practice Address - Phone:818-487-9100
Practice Address - Fax:818-487-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27771111N00000X
CAC24147208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty