AVANTA MEDICAL GROUP NPI 1770429102

NPI Information

  • NPI: 1770429102
  • Provider Name: AVANTA MEDICAL GROUP
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Address: 14649 VICTORY BLVD STE 22
    VAN NUYS, CA
    ZIP 91411
  • Phone: (818) 796-5558

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NPI Details

AVANTA MEDICAL GROUP is a general practice in Van Nuys, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee AVANTA MEDICAL GROUP NPI is 1770429102. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

14649 VICTORY BLVD STE 22
VAN NUYS, CA
ZIP 91411-101
Phone: (818) 796-5558

The provider's authorized official is Vyacheslav Davtian .
The authorized official title is Ceo and has the following contact phone number (818) 796-5558.

The enumeration date for this NPI number is 4/27/2026 and was last updated on 4/27/2026.

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
1163WI0500XRegistered NurseInfusion TherapyNo
2163WP0000XRegistered NursePain ManagementNo
3213E00000XPodiatristNo
4208D00000XGeneral PracticeYes

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: 11/21/2025

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