Healthcare Provider Details

I. General information

NPI: 1154245108
Provider Name (Legal Business Name): MILA HEART AND VASCULAR CENTER, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16542 VENTURA BLVD STE 320
ENCINO CA
91436-5060
US

IV. Provider business mailing address

6720 VALLEY CIRCLE BLVD
WEST HILLS CA
91307-2809
US

V. Phone/Fax

Practice location:
  • Phone: 323-770-9607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEZIRE KHOSRAVI
Title or Position: CREDENTIAL COORDINATOR
Credential: NP
Phone: 323-770-9607