Provider Demographics
NPI:1710114236
Name:VALLEY COMMUNITY MULTICARE HEALTH SERVICES
Entity Type:Organization
Organization Name:VALLEY COMMUNITY MULTICARE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOUKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-258-2256
Mailing Address - Street 1:18607 VENTURA BLVD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4172
Mailing Address - Country:US
Mailing Address - Phone:805-582-0355
Mailing Address - Fax:805-582-2285
Practice Address - Street 1:18607 VENTURA BLVD.
Practice Address - Street 2:SUITE 204
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4172
Practice Address - Country:US
Practice Address - Phone:805-582-0355
Practice Address - Fax:805-582-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty