Provider Demographics
NPI:1225476567
Name:MEDLAND MEDICAL INC.
Entity Type:Organization
Organization Name:MEDLAND MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-980-9825
Mailing Address - Street 1:149 S BARRINGTON AVE
Mailing Address - Street 2:#754
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3310
Mailing Address - Country:US
Mailing Address - Phone:323-980-9825
Mailing Address - Fax:310-471-9521
Practice Address - Street 1:1633 PACIFIC AVE
Practice Address - Street 2:#141
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-1896
Practice Address - Country:US
Practice Address - Phone:323-980-9825
Practice Address - Fax:310-471-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty