Healthcare Provider Details

I. General information

NPI: 1336471135
Provider Name (Legal Business Name): MOLANI MEDICAL GROUP A PROFESSIONAL MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD #415
SHERMAN OAKS CA
91403-1801
US

IV. Provider business mailing address

20801 SARDINIA WAY
PORTER RANCH CA
91326-4432
US

V. Phone/Fax

Practice location:
  • Phone: 818-528-1080
  • Fax:
Mailing address:
  • Phone: 818-998-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC53794
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC53899
License Number StateCA

VIII. Authorized Official

Name: DR. MUHAMMAD ANWAR MOLANI
Title or Position: DIRECTOR
Credential: M.D.
Phone: 818-528-1080