Healthcare Provider Details

I. General information

NPI: 1649065384
Provider Name (Legal Business Name): INTER VALLEY WELLNESS AND REGENERATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S BRAND BLVD STE A-105
GLENDALE CA
91204-1701
US

IV. Provider business mailing address

317 S BRAND BLVD STE A-105
GLENDALE CA
91204-1701
US

V. Phone/Fax

Practice location:
  • Phone: 818-338-6860
  • Fax: 888-425-9079
Mailing address:
  • Phone: 818-338-6860
  • Fax: 888-425-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MAXIM MORADIAN
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 818-913-9356