Provider Demographics
NPI:1861820623
Name:PANORAMA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PANORAMA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKNIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:818-456-7918
Mailing Address - Street 1:14526 ROSCOE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4176
Mailing Address - Country:US
Mailing Address - Phone:818-456-7918
Mailing Address - Fax:
Practice Address - Street 1:14526 ROSCOE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4176
Practice Address - Country:US
Practice Address - Phone:818-456-7918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty