MEDICARE: FIRST CHOICE WOMAN'S CLINIC, A PROFESSIONAL NURSING CORPORATION

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	207V00000X	Obstetrics & Gynecology Physician	235676	CA

General Provider Information

NPI Number	:	1699204552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE WOMAN'S CLINIC, A PROFESSIONAL NURSING CORPORATION

Provider Business Mailing Address
First Line	:	8162 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4806
Country	:	US
Telephone Number	:	818-324-1227
Fax Number	:

Provider Business Practice Location Address
First Line	:	8162 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4806
Country	:	US
Telephone Number	:	818-787-0060
Fax Number	:	818-787-0061

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSAN HAROUT MAADANIAN
Credential	:	CNM
Telephone Number	:	818-324-1227

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	06/05/2017

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