Healthcare Provider Details

I. General information

NPI: 1831867324
Provider Name (Legal Business Name): ISLAND MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N MACLAY AVE
SAN FERNANDO CA
91340-2932
US

IV. Provider business mailing address

601 N CRESCENT DR
BEVERLY HILLS CA
90210-3329
US

V. Phone/Fax

Practice location:
  • Phone: 310-409-6559
  • Fax: 213-745-0152
Mailing address:
  • Phone: 310-409-6559
  • Fax: 213-745-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL YADEGARI
Title or Position: CEO
Credential: MD
Phone: 310-409-6559