Provider Demographics
NPI:1215960828
Name:SOUTH VALLEY HEART CENTER, INC
Entity type:Organization
Organization Name:SOUTH VALLEY HEART CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SHAHAB
Authorized Official - Last Name:MANAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-1445
Mailing Address - Street 1:PO BOX 260602
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0602
Mailing Address - Country:US
Mailing Address - Phone:818-990-1445
Mailing Address - Fax:818-990-1444
Practice Address - Street 1:18345 VENTURA BLVD STE 420
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4243
Practice Address - Country:US
Practice Address - Phone:818-990-1445
Practice Address - Fax:818-990-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G698750Medicaid
CA00G69875OtherBLUE SHIELD
CA00G698750Medicaid