Healthcare Provider Details

I. General information

NPI: 1669783122
Provider Name (Legal Business Name): FAMILIA SANA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 VANOWEN ST SUITE # 206
VAN NUYS CA
91405-3606
US

IV. Provider business mailing address

15211 VANOWEN ST SUITE #206
VAN NUYS CA
91405-3606
US

V. Phone/Fax

Practice location:
  • Phone: 818-756-6916
  • Fax: 818-756-6986
Mailing address:
  • Phone: 818-756-6916
  • Fax: 818-756-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VAHAN MADATOVIAN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 818-756-6916