Healthcare Provider Details

I. General information

NPI: 1477464410
Provider Name (Legal Business Name): AUREVIA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N CENTRAL AVE STE 100
GLENDALE CA
91203-2961
US

IV. Provider business mailing address

320 N CENTRAL AVE STE 100
GLENDALE CA
91203-2961
US

V. Phone/Fax

Practice location:
  • Phone: 213-290-0757
  • Fax: 626-243-2600
Mailing address:
  • Phone: 213-290-0757
  • Fax: 626-243-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANOUSHEH ASHOURI
Title or Position: CEO
Credential: MD
Phone: 213-290-0757