Provider Demographics
NPI:1255161626
Name:VALIA LIFESTYLE A MEDICAL CORP
Entity type:Organization
Organization Name:VALIA LIFESTYLE A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:EDSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-370-4704
Mailing Address - Street 1:9229 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5501
Mailing Address - Country:US
Mailing Address - Phone:323-282-7280
Mailing Address - Fax:888-827-2167
Practice Address - Street 1:9229 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5501
Practice Address - Country:US
Practice Address - Phone:323-282-7280
Practice Address - Fax:888-827-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty