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General NPI Number Information
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NPI Number | 1497944557
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Entity Type | Organization
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Legal Business Name | ABM MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/13/2017
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Provider Practice Location Address
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Address Line | 22554 VENTURA BLVD STE 201 STE 201
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1480
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Country | US
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Telephone | 818-222-8042
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Fax | 818-222-2240
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Provider Business Mailing Address
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Address Line | 22554 VENTURA BLVD STE 201 STE 201
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1480
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Country | US
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Telephone | 818-222-8042
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Fax | 818-222-2240
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARYAM MORTEZAIEFARD
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Credential | D.O.
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Telephone | 818-222-8042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 20A7100
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License Number State | CA
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