Provider Demographics
NPI:1649065384
Name:INTER VALLEY WELLNESS AND REGENERATION CENTER
Entity type:Organization
Organization Name:INTER VALLEY WELLNESS AND REGENERATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-913-9356
Mailing Address - Street 1:317 S BRAND BLVD STE A-105
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1701
Mailing Address - Country:US
Mailing Address - Phone:818-338-6860
Mailing Address - Fax:888-425-9079
Practice Address - Street 1:317 S BRAND BLVD STE A-105
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1701
Practice Address - Country:US
Practice Address - Phone:818-338-6860
Practice Address - Fax:888-425-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty