| Vivo Medical Group Inc | |
|
1030 S Glendale Ave Ste 502 Glendale CA 91205-2820 | |
| (747) 228-6861 | |
| Not Available |
| Full Name | Vivo Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1030 S Glendale Ave Ste 502, Glendale, California |
| Authorized Official Name and Position | Edward Azar (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 4155164969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivo Medical Group Inc 1030 S Glendale Ave Ste 502 Glendale CA 91205-2820 Ph: (747) 228-6861 | Vivo Medical Group Inc 1030 S Glendale Ave Ste 502 Glendale CA 91205-2820 Ph: (747) 228-6861 |
| NPI Number | 1407587942 |
|---|---|
| Provider Enumeration Date | 06/23/2022 |
| Last Update Date | 06/23/2022 |
| Medicare PECOS PAC ID | 6507236866 |
|---|---|
| Medicare Enrollment ID | O20221230001658 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407587942 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Edward M Young |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1447324850 PECOS PAC ID: 9032188230 Enrollment ID: I20040924000766 |
| Provider Name | Edward Azar |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1003291832 PECOS PAC ID: 9537461744 Enrollment ID: I20161026002275 |
| Provider Name | Lilith Garibyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003526724 PECOS PAC ID: 6406211176 Enrollment ID: I20230502002211 |
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