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General NPI Number Information
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NPI Number | 1700285301
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Entity Type | Organization
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Legal Business Name | LV MEDICAL GROUP, INC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 12826 VICTORY BLVD STE 5
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City | N HOLLYWOOD
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State | CA
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Zip | 91606-3013
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Country | US
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Telephone | 818-670-8990
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Fax | 818-670-8991
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Provider Business Mailing Address
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Address Line | 222 MONTEREY RD UNIT 101
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City | GLENDALE
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State | CA
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Zip | 91206-2052
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Country | US
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Telephone | 818-395-2701
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Fax | 818-549-9779
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Authorized Official
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Title or Position | PT
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Name | LEVON VIRABOV
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Credential |
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Telephone | 818-670-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT 19314
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License Number State | CA
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