Healthcare Provider Details

I. General information

NPI: 1285538306
Provider Name (Legal Business Name): MYATLAS PROVIDER GROUP CA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 LANKERSHIM BLVD
NORTH HOLLYWOOD CA
91601-3186
US

IV. Provider business mailing address

5250 LANKERSHIM BLVD STE 500
NORTH HOLLYWOOD CA
91601-3187
US

V. Phone/Fax

Practice location:
  • Phone: 305-701-4286
  • Fax: 305-703-3502
Mailing address:
  • Phone: 305-701-4286
  • Fax: 305-703-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VIKRAM BAKHRU
Title or Position: PRESIDENT
Credential: MD
Phone: 305-701-4286