Healthcare Provider Details

I. General information

NPI: 1831539485
Provider Name (Legal Business Name): ANVAR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9335 RESEDA BLVD STE 100
NORTHRIDGE CA
91324
US

IV. Provider business mailing address

12021 WILSHIRE BLVD # 745
LOS ANGELES CA
90025-1206
US

V. Phone/Fax

Practice location:
  • Phone: 310-445-5999
  • Fax: 310-445-6622
Mailing address:
  • Phone: 310-445-5999
  • Fax: 310-445-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BARDIA ANVAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-445-5999