Provider Demographics
NPI:1659625002
Name:THRIVE COMPREHENSIVE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:THRIVE COMPREHENSIVE MEDICAL GROUP, INC.
Other - Org Name:THRIVE COMPREHENSIVE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CME
Authorized Official - Prefix:
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:SHLOMY
Authorized Official - Last Name:ARASHEBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-600-1472
Mailing Address - Street 1:PO BOX 573041
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-3041
Mailing Address - Country:US
Mailing Address - Phone:818-600-1472
Mailing Address - Fax:818-600-1494
Practice Address - Street 1:18607 VENTURA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6804
Practice Address - Country:US
Practice Address - Phone:818-602-6761
Practice Address - Fax:818-600-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115108208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR535AOtherPTAN
CAA115108OtherCA MEDICAL BOARD