Provider Demographics
NPI:1700285301
Name:LV MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:LV MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:LEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRABOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-670-8990
Mailing Address - Street 1:222 MONTEREY RD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2052
Mailing Address - Country:US
Mailing Address - Phone:818-395-2701
Mailing Address - Fax:818-549-9779
Practice Address - Street 1:12826 VICTORY BLVD
Practice Address - Street 2:STE 5
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3013
Practice Address - Country:US
Practice Address - Phone:818-670-8990
Practice Address - Fax:818-670-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19314208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty