Provider Demographics
NPI:1518686377
Name:CANBY COMMUNITY CLINIC, INC.
Entity Type:Organization
Organization Name:CANBY COMMUNITY CLINIC, INC.
Other - Org Name:PURA VIDA COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:AREV
Authorized Official - Middle Name:
Authorized Official - Last Name:ADANALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-383-9383
Mailing Address - Street 1:160 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1308
Mailing Address - Country:US
Mailing Address - Phone:818-383-9383
Mailing Address - Fax:
Practice Address - Street 1:7601 CANBY AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2953
Practice Address - Country:US
Practice Address - Phone:818-383-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center