Provider Demographics
NPI:1790496073
Name:MYANYWHEREMD
Entity Type:Organization
Organization Name:MYANYWHEREMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATANELOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:424-245-0849
Mailing Address - Street 1:1471 S WOOSTER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3462
Mailing Address - Country:US
Mailing Address - Phone:424-245-0849
Mailing Address - Fax:
Practice Address - Street 1:20301 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0934
Practice Address - Country:US
Practice Address - Phone:424-245-0849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Multi-Specialty
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty