Healthcare Provider Details

I. General information

NPI: 1720199797
Provider Name (Legal Business Name): CENTER FOR INTERVENTIONAL CARDIOLOGY & NEPHROLOGY MED GP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 815E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8635 W 3RD ST STE# 695W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-1770
  • Fax: 424-265-5819
Mailing address:
  • Phone: 310-652-2744
  • Fax: 310-967-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUITA BALAKHANE
Title or Position: PHYSICIAN
Credential: M.D.,
Phone: 310-652-2744