Provider Demographics
NPI:1497122824
Name:ANVAR MEDICAL GROUP
Entity Type:Organization
Organization Name:ANVAR MEDICAL GROUP
Other - Org Name:VALLEY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-349-9966
Mailing Address - Street 1:12021 WILSHIRE BLVD # 745
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:818-349-9966
Mailing Address - Fax:818-501-1892
Practice Address - Street 1:9346 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2405
Practice Address - Country:US
Practice Address - Phone:818-349-9966
Practice Address - Fax:818-349-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543446332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site