Provider Demographics
NPI:1588804124
Name:EAST VALLEY PANORAMA, INC
Entity Type:Organization
Organization Name:EAST VALLEY PANORAMA, INC
Other - Org Name:PANORAMA HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOFYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-371-5097
Mailing Address - Street 1:18345 VENTURA BLVD.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4232
Mailing Address - Country:US
Mailing Address - Phone:818-371-5097
Mailing Address - Fax:818-716-8437
Practice Address - Street 1:18345 VENTURA BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4232
Practice Address - Country:US
Practice Address - Phone:818-371-5097
Practice Address - Fax:818-716-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center