Provider Demographics
NPI:1295598571
Name:VIVA MED CENTER PC
Entity type:Organization
Organization Name:VIVA MED CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-673-2600
Mailing Address - Street 1:17609 VENTURA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5121
Mailing Address - Country:US
Mailing Address - Phone:844-673-2600
Mailing Address - Fax:844-673-2601
Practice Address - Street 1:17609 VENTURA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5121
Practice Address - Country:US
Practice Address - Phone:844-673-2600
Practice Address - Fax:844-673-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty