Provider Demographics
NPI:1205182623
Name:HEALTHY CHOICE CLINIC
Entity Type:Organization
Organization Name:HEALTHY CHOICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-992-5252
Mailing Address - Street 1:20969 VENTURA BLVD
Mailing Address - Street 2:23
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2305
Mailing Address - Country:US
Mailing Address - Phone:818-992-5252
Mailing Address - Fax:818-992-5292
Practice Address - Street 1:20969 VENTURA BLVD
Practice Address - Street 2:23
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2305
Practice Address - Country:US
Practice Address - Phone:818-992-5252
Practice Address - Fax:818-992-5292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MITRA RAZIPOUR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293731302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherMULTI SEPECIALTY/ CORPORATION