Organization Name: | MAX M GHANNADI MD MEDICAL CORP |
NPI Number: | 1003050873 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MAX M GHANNADI (PRESIDENT) |
Mailing Address: | 14103 Victory Blvd Suite 7 Van Nuys |
State: | CA US |
Postal Code: | 91401 |
Phone Number: | 8189940000 |
Fax Number: | 8189882949 |
NPI Enumeration Date: | 04/24/2009 |
NPI Last Update Date: | 10/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A102618 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |