Provider Demographics
NPI:1518418219
Name:WEST VALLEY INTENSIVIST MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WEST VALLEY INTENSIVIST MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRYAR
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:YADEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-609-7536
Mailing Address - Street 1:18399 VENTURA BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4233
Mailing Address - Country:US
Mailing Address - Phone:818-609-7536
Mailing Address - Fax:818-344-9670
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-609-7536
Practice Address - Fax:818-344-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61475174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty