Provider Demographics
NPI:1356444640
Name:VALENCIA WOMEN'S PAVILION
Entity type:Organization
Organization Name:VALENCIA WOMEN'S PAVILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AHDOOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-700-8300
Mailing Address - Street 1:23861 MCBEAN PARKWAY
Mailing Address - Street 2:UNIT C-6
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-222-7822
Mailing Address - Fax:661-254-3221
Practice Address - Street 1:23861 MCBEAN PKWY
Practice Address - Street 2:UNIT C-6
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2058
Practice Address - Country:US
Practice Address - Phone:661-222-7822
Practice Address - Fax:661-254-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67069Medicare UPIN
CAW18594Medicare ID - Type Unspecified