Provider Demographics
NPI:1821734732
Name:MIDVALLEY MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:MIDVALLEY MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSAGAV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-851-5540
Mailing Address - Street 1:14550 ARCHWOOD ST # 106
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4604
Mailing Address - Country:US
Mailing Address - Phone:818-951-5540
Mailing Address - Fax:818-851-5544
Practice Address - Street 1:14550 ARCHWOOD ST # 106
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4604
Practice Address - Country:US
Practice Address - Phone:818-951-5540
Practice Address - Fax:818-851-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center