MEDICARE: CRANBELVE MEDICAL GROUP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1548729007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANBELVE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	9112 SUNLAND BLVD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-2052
Country	:	US
Telephone Number	:	818-465-8238
Fax Number	:

Provider Business Practice Location Address
First Line	:	9112 SUNLAND BLVD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-2052
Country	:	US
Telephone Number	:	818-465-8238
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ROBERT CARPIO
Credential	:
Telephone Number	:	818-465-8238

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	03/14/2019

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