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General NPI Number Information
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NPI Number | 1649065384
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Entity Type | Organization
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Legal Business Name | INTER VALLEY WELLNESS AND REGENERATION CENTER
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 317 S BRAND BLVD STE A-105
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City | GLENDALE
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State | CA
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Zip | 91204-1701
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Country | US
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Telephone | 818-338-6860
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Fax | 888-425-9079
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Provider Business Mailing Address
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Address Line | 317 S BRAND BLVD STE A-105
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City | GLENDALE
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State | CA
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Zip | 91204-1701
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Country | US
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Telephone | 818-338-6860
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Fax | 888-425-9079
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MAXIM MORADIAN
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Credential | MD
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Telephone | 818-913-9356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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