| Organization Name: | MEDWISE MEDICAL CLINIC, INC |
| NPI Number: | 1609813096 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHALIMAN EIVAZZADEH (OWNER) |
| Mailing Address: | 540 N Central Ave Suite 203 Glendale |
| State: | CA US |
| Postal Code: | 912031916 |
| Phone Number: | 8182420500 |
| Fax Number: | |
| NPI Enumeration Date: | 06/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A42072 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |