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General NPI Number Information
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NPI Number | 1124860507
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Entity Type | Organization
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Legal Business Name | PROXIMA MEDICAL GROUP
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 800 S CENTRAL AVE STE 206
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City | GLENDALE
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State | CA
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Zip | 91204-4379
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Country | US
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Telephone | 818-862-4000
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Fax | 818-616-8660
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Provider Business Mailing Address
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Address Line | 800 S CENTRAL AVE STE 206
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City | GLENDALE
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State | CA
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Zip | 91204-4379
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Country | US
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Telephone | 818-862-4000
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Fax | 818-616-8660
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Authorized Official
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Title or Position | CEO
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Name | HAPETNAK SHAYBEKYAN
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Credential | MD
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Telephone | 818-862-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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