Provider Demographics
NPI:1154478063
Name:VALLEY ENDOCRINE & DIABETES CONSULTANS, INC
Entity Type:Organization
Organization Name:VALLEY ENDOCRINE & DIABETES CONSULTANS, INC
Other - Org Name:VALLEY ENDOCRINE &DIABETES CONSULTANS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:Q
Authorized Official - Last Name:MACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-239-0288
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-239-0288
Mailing Address - Fax:818-239-0289
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:SUITE 225
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-239-0288
Practice Address - Fax:818-239-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16540Medicare ID - Type UnspecifiedPROVIDER NUMBER