Healthcare Provider Details

I. General information

NPI: 1962679431
Provider Name (Legal Business Name): PROHEALTH-GLENDALE OCCUPATIONAL MEDICAL GRP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W. EULALIA STREET SUITE 101
GLENDALE CA
91204
US

IV. Provider business mailing address

222 W. EULALIA STREET SUITE 101
GLENDALE CA
91204
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-4800
  • Fax: 818-246-4805
Mailing address:
  • Phone: 818-246-4800
  • Fax: 818-246-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number20A6596
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number20A6596
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number20A6596
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number20A6596
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20A6596
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number20A6596
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number20A6596
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. SOHEIL S YOUNAI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-246-4800