Provider Demographics
NPI:1356099253
Name:SPVN MEDICAL GROUP
Entity type:Organization
Organization Name:SPVN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRESSER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:818-860-4554
Mailing Address - Street 1:13651 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4045
Mailing Address - Country:US
Mailing Address - Phone:818-860-4554
Mailing Address - Fax:818-860-4557
Practice Address - Street 1:13651 OXNARD ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-4045
Practice Address - Country:US
Practice Address - Phone:818-860-4554
Practice Address - Fax:818-860-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty