MEDICARE: HEALTHY WAY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	20A13859	CA

General Provider Information

NPI Number	:	1306399878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY WAY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1150
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91209-1150
Country	:	US
Telephone Number	:	818-484-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 E COLORADO ST STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1298
Country	:	US
Telephone Number	:	818-484-5434
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	VIOLETTA MAILYAN
Credential	:	D.O.
Telephone Number	:	818-484-5434

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	11/22/2016

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