MEDICARE: MAHIN GHANEVATI D.O., PH.D., M.S.

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	20A12583	CA

General Provider Information

NPI Number	:	1881915627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHIN GHANEVATI D.O., PH.D., M.S.

Provider Business Mailing Address
First Line	:	191 S BUENA VISTA ST STE 220
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4563
Country	:	US
Telephone Number	:	818-557-2671
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 S BUENA VISTA ST STE 220
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4563
Country	:	US
Telephone Number	:	818-557-2671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	05/14/2015

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