Provider Demographics
NPI:1104984327
Name:FAMILY MEDICINE ASSOCIATES OF NORTHRIDGE A MEDICAL GROUP INC
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF NORTHRIDGE A MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKHOVAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-727-1515
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-727-1515
Mailing Address - Fax:818-727-7997
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-727-1515
Practice Address - Fax:818-727-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061720Medicaid
CAGR0061720Medicaid
CA6338250001Medicare NSC