Healthcare Provider Details

I. General information

NPI: 1700277795
Provider Name (Legal Business Name): INTERNATIONAL MEDIA ARTS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24237 MAIN ST
NEWHALL CA
91321-2907
US

IV. Provider business mailing address

24237 MAIN ST
NEWHALL CA
91321-2907
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-6302
  • Fax: 661-259-6309
Mailing address:
  • Phone: 661-259-6302
  • Fax: 661-259-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MUSABBIR HOSSAIN CHOWDHURY
Title or Position: PRESIDENT
Credential:
Phone: 661-259-6302