Provider Demographics
NPI:1184746729
Name:AFFILIATES IN MEDICAL SPECIALTIES MEDICAL GROUP INC
Entity type:Organization
Organization Name:AFFILIATES IN MEDICAL SPECIALTIES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:NANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-347-2921
Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-706-2477
Mailing Address - Fax:818-706-2368
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-706-2477
Practice Address - Fax:818-706-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1666Medicare ID - Type UnspecifiedMEDICARE