Provider Demographics
NPI:1659919660
Name:THRIVE MEDICAL, INC.
Entity Type:Organization
Organization Name:THRIVE MEDICAL, INC.
Other - Org Name:THRIVE MEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOOMAN
Authorized Official - Middle Name:JEFF
Authorized Official - Last Name:NAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-692-0023
Mailing Address - Street 1:3847 WESTFALL DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4157
Mailing Address - Country:US
Mailing Address - Phone:818-692-0023
Mailing Address - Fax:
Practice Address - Street 1:18740 VENTURA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3366
Practice Address - Country:US
Practice Address - Phone:818-906-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty