Provider Demographics
NPI:1306038062
Name:VENUS SPECIALTY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VENUS SPECIALTY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVAHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-217-4351
Mailing Address - Street 1:17075 DEVONSHIRE ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5408
Mailing Address - Country:US
Mailing Address - Phone:818-217-4351
Mailing Address - Fax:818-217-4104
Practice Address - Street 1:17075 DEVONSHIRE ST STE 208
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5408
Practice Address - Country:US
Practice Address - Phone:818-217-4351
Practice Address - Fax:818-217-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306038062Medicare PIN