MID VALLEY VASCULAR CENTER, INC (NPI# 1790187169) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790187169 |
| Entity Type | Organization |
| Organization Name | MID VALLEY VASCULAR CENTER, INC |
| Practice Address |
7640 Tampa Ave Suite 101a Reseda CA 91335-1735 |
| Mailing Address |
4930 Balboa Blvd Suite 261278 Encino CA 91426-7001 |
| Practice Telephone | 8187181600 |
| Practice Fax Number | 8183431612 |
| Mailing Telephone | 8187181600 |
| Mailing Fax Number | 8183431612 |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-11-05 |
| Authorized Official Name | DR. LEO POLOSAJIAN (PRESIDENT/CEO) |
| Authorized Official Telephone | 8184543638 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Street Address |
7640 TAMPA AVE SUITE 101A |
| City | RESEDA |
| State | CA |
| Zip Code | 91335-1735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912122631 | Leo Polosajian, Md, A Professional Medical Corporation | Internal Medicine | 7640 Tampa Ave, Suite 101, Reseda, CA 91335-1735 | 2007-04-16 |
| 1659807717 | Tampa Surgical Center LLC | Clinic/Center | 7640 Tampa Ave, Suite 102, Reseda, CA 91335-1700 | 2017-05-11 |
| 1861923625 | Mid-valley Surgical Center, Inc. | Clinic/Center | 7640 Tampa Ave, Suite 102, Reseda, CA 91335-1700 | 2017-03-23 |
| 1396907119 | Moinakhtar Lala | Internal Medicine | 7640 Tampa Ave, Suite 101, Reseda, CA 91335-1735 | 2008-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968754 | Thomas Allen Hambright | Massage Therapist | 7510 Corbin Avenue, Unit #8, Reseda, CA 91335 | 2020-07-01 |
| 1558912014 | Harriet Ann Bickel | Technician | 18006 Hatton St., Reseda, CA 91335 | 2019-09-26 |
| 1528627106 | Topanga Hospice Care, Inc. | Hospice Care, Community Based | 5311 Topanga Canyon Blvd., Suite 302, Reseda, CA 91335 | 2019-06-07 |
| 1881174043 | Aludra Inc. | Hospice Care, Community Based | 18325 Sherman Way, Suite A, Reseda, CA 91335 | 2018-08-17 |
| 1417437658 | Buonora Development, Inc | Physical Therapist | 19325 Sherman Way, Reseda, CA 91335 | 2018-08-16 |
| 1770073793 | Deanna Marie Niekamp | Counselor | 7232 Canby Ave. #4,5,6, Reseda, CA 91335 | 2018-05-15 |
| 1013423383 | Bassa Logistic Inc | Non-emergency Medical Transport (VAN) | 19537 Valerio Street, Reseda, CA 91335 | 2017-12-21 |
| 1093237919 | Belinda Reser | Counselor | 7101 Baird St, Reseda, CA 91335 | 2017-07-12 |
| 1720500028 | Hermine Karapetyan | Hearing Instrument Specialist | 19367 Victory Blvd., Suite 14, Reseda, CA 91335 | 2017-07-09 |
| 1902352461 | Baird Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 7701 Baird Avenue, Reseda, CA 91335 | 2016-08-25 |
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| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.