Healthcare Provider Details

I. General information

NPI: 1972398436
Provider Name (Legal Business Name): XCLUSIVE HEALTHCARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

801 S CHEVY CHASE DR STE 100
GLENDALE CA
91205-4437
US

IV. Provider business mailing address

801 S CHEVY CHASE DR STE 100
GLENDALE CA
91205-4437
US

V. Phone/Fax

Practice location:
  • Phone: 310-933-9779
  • Fax: 310-933-9559
Mailing address:
  • Phone: 310-933-9779
  • Fax: 310-933-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHBOD PAYA
Title or Position: CEO/OWNER
Credential: MD
Phone: 310-933-9779