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General NPI Number Information
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NPI Number | 1972124675
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Entity Type | Organization
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Legal Business Name | ADVANCED WELLNESS WEST VALLEY MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 4116 W MAGNOLIA BLVD STE 100
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City | BURBANK
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State | CA
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Zip | 91505-2706
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Country | US
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Telephone | 310-879-9266
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Fax | 818-279-0787
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Provider Business Mailing Address
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Address Line | 18653 VENTURA BLVD # 384
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City | TARZANA
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State | CA
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Zip | 91356-4103
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Country | US
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Telephone | 310-879-9266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALLEN L LAWRENCE
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Credential |
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Telephone | 310-879-9266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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