Provider Demographics
NPI:1336471135
Name:MOLANI MEDICAL GROUP A PROFESSIONAL MEDICAL CORP.
Entity Type:Organization
Organization Name:MOLANI MEDICAL GROUP A PROFESSIONAL MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:ANWAR
Authorized Official - Last Name:MOLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-528-1080
Mailing Address - Street 1:20801 SARDINIA WAY
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4432
Mailing Address - Country:US
Mailing Address - Phone:818-998-1578
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:#415
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1801
Practice Address - Country:US
Practice Address - Phone:818-528-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53794207Q00000X
CAC53899207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336471135Medicaid
CACY700AMedicare PIN