Provider Demographics
NPI:1467638114
Name:THE MATERNITY CLINIC
Entity Type:Organization
Organization Name:THE MATERNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMROOZ
Authorized Official - Middle Name:H
Authorized Official - Last Name:TABIBZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-909-2229
Mailing Address - Street 1:6618 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4617
Mailing Address - Country:US
Mailing Address - Phone:818-909-2229
Mailing Address - Fax:818-909-2224
Practice Address - Street 1:6618 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4617
Practice Address - Country:US
Practice Address - Phone:818-909-2229
Practice Address - Fax:818-909-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57734261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center