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NPI Code Detail

MEDICARE: MAR VISTA HEALTH CENTER, INC

MEDICARE: MAR VISTA HEALTH CENTER, INC
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
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1720301559
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAR VISTA HEALTH CENTER, INC
Provider Business Mailing Address
First Line : 2980 N BEVERLY GLEN CIR
Second Line : STE 301
City : LOS ANGELES
State : CA
Zip : 90077-1726
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3030 SAWTELLE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-1408
Country : US
Telephone Number : 310-391-2617
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : MICHAEL SINEL
Credential : MD
Telephone Number : 310-391-2617
Provider Enumeration Date : 03/08/2010
Last Update Date : 07/18/2011

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Directions to “MAR VISTA HEALTH CENTER, INC ” Practice Location

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