Healthcare Provider Details

I. General information

NPI: 1073399804
Provider Name (Legal Business Name): DOA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 02/14/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24335 MAGIC MOUNTAIN PKWY
SANTA CLARITA CA
91355-3402
US

IV. Provider business mailing address

3893 VILLA VISTA PL
CONCORD CA
94521-2028
US

V. Phone/Fax

Practice location:
  • Phone: 818-624-1290
  • Fax:
Mailing address:
  • Phone: 818-624-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VAHEH SHIRVANIAN
Title or Position: MD
Credential: MD
Phone: 818-624-1290