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General NPI Number Information
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NPI Number | 1245549443
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Entity Type | Organization
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Legal Business Name | VIDA FAMILY PRACTICE PC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 435 ARDEN AVE SUITE # 330
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City | GLENDALE
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State | CA
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Zip | 91203-4016
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Country | US
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Telephone | 818-548-8001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5869
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City | GLENDALE
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State | CA
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Zip | 91221-5869
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Country | US
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Telephone | 818-588-8178
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PRESIDENT
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Name | VIGEN VICK ABOVIAN
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Credential | M.D.
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Telephone | 818-588-8178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A106757
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License Number State | CA
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