Healthcare Provider Details

I. General information

NPI: 1235351388
Provider Name (Legal Business Name): OB-GYN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST 501
VAN NUYS CA
91405-3605
US

IV. Provider business mailing address

15243 VANOWEN ST 501
VAN NUYS CA
91405-3605
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-2330
  • Fax:
Mailing address:
  • Phone: 818-781-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HORMOZ FARHAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-781-2330