Provider Demographics
NPI:1073988614
Name:WOODLAND HILLS MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:WOODLAND HILLS MEDICAL CLINIC INC.
Other - Org Name:WOODLAND HILLS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:MIRSHOJAE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-888-7009
Mailing Address - Street 1:19825 VENTURA BLVD.
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-888-7009
Mailing Address - Fax:818-888-7018
Practice Address - Street 1:19825 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2627
Practice Address - Country:US
Practice Address - Phone:818-888-7009
Practice Address - Fax:818-888-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6577284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital