| Caspian Medical Clinic, Corp | |
|
14103 Victory Blvd Suite 7 Van Nuys CA 91401-1998 | |
| (818) 994-0000 | |
| (818) 988-2949 |
| Full Name | Caspian Medical Clinic, Corp |
|---|---|
| Speciality | General Practice |
| Location | 14103 Victory Blvd, Van Nuys, California |
| Authorized Official Name and Position | Max Mahmoud Ghannadi (OWNER) |
| Authorized Official Contact | 8189940000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caspian Medical Clinic, Corp 14103 Victory Blvd Suite 7 Van Nuys CA 91401-1998 Ph: (818) 994-0000 | Caspian Medical Clinic, Corp 14103 Victory Blvd Suite 7 Van Nuys CA 91401-1998 Ph: (818) 994-0000 |
| NPI Number | 1275765612 |
|---|---|
| Provider Enumeration Date | 08/19/2009 |
| Last Update Date | 09/23/2010 |
| Medicare PECOS PAC ID | 3072708460 |
|---|---|
| Medicare Enrollment ID | O20101111000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275765612 | NPI | - | NPPES |
| A102618 | Other | CA | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A102618 (California) | Primary |
| Provider Name | Max M Ghannadi |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1114191798 PECOS PAC ID: 8123170248 Enrollment ID: I20090720000535 |
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