Healthcare Provider Details

I. General information

NPI: 1598984288
Provider Name (Legal Business Name): AMAVI A PROFESSIONAL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 WHITTIER BLVD
LOS ANGELES CA
90023-1441
US

IV. Provider business mailing address

2705 WHITTIER BLVD
LOS ANGELES CA
90023-1441
US

V. Phone/Fax

Practice location:
  • Phone: 323-263-3861
  • Fax: 323-262-7132
Mailing address:
  • Phone: 323-263-3861
  • Fax: 323-262-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA51722
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License NumberA51722
License Number StateCA

VIII. Authorized Official

Name: DR. VICTOR MANUEL PEDROZA
Title or Position: MD
Credential: M.D
Phone: 323-263-3861