Healthcare Provider Details

I. General information

NPI: 1497122824
Provider Name (Legal Business Name): ANVAR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9346 CORBIN AVE
NORTHRIDGE CA
91324-2405
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 818-349-9966
  • Fax: 818-349-5615
Mailing address:
  • Phone: 818-349-9966
  • Fax: 818-501-1892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number543446
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL ANVAR
Title or Position: COO
Credential:
Phone: 818-349-9966