Provider Demographics
NPI:1750795613
Name:SOUTH VALLEY PHYSICIAN GROUP, INC.
Entity type:Organization
Organization Name:SOUTH VALLEY PHYSICIAN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-528-1293
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-528-1293
Mailing Address - Fax:818-654-8444
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-528-1293
Practice Address - Fax:818-654-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty