MEDWISE MEDICAL CLINIC INC NPI 1609813096

NPI Information

NPI: 1609813096
Provider Name: MEDWISE MEDICAL CLINIC, INC

Former Legal Business Name: MEDWISE MEDICAL CLINIC

Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
540 N CENTRAL AVE
SUITE 203
GLENDALE, CA
ZIP 91203
Phone: (818) 242-0500
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MEDWISE MEDICAL CLINIC, INC is a general practice in Glendale, CA. MEDWISE MEDICAL CLINIC, INC NPI is 1609813096. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Medwise Medical Clinic.

The provider's business location address is:

540 N CENTRAL AVE
SUITE 203
GLENDALE, CA
ZIP 91203-916
Phone: (818) 242-0500

The provider's authorized official is Shaliman Eivazzadeh .
The authorized official title is Owner and has the following contact phone number (818) 242-0500.

The enumeration date for this NPI number is 6/2/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		A42072	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00A420721	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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