Healthcare Provider Details

I. General information

NPI: 1740079516
Provider Name (Legal Business Name): THRIVE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 N GLENOAKS BLVD
BURBANK CA
91504-2835
US

IV. Provider business mailing address

2010 N GLENOAKS BLVD
BURBANK CA
91504-2835
US

V. Phone/Fax

Practice location:
  • Phone: 818-477-7624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VILIK HARUTYUNYAN
Title or Position: CEO
Credential:
Phone: 818-477-7624