Provider Demographics
NPI:1386900074
Name:SYLMAR HEALTH CARE PROFESSIONALS MEDICAL GROUP INC.
Entity type:Organization
Organization Name:SYLMAR HEALTH CARE PROFESSIONALS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSHANG
Authorized Official - Middle Name:DANNY
Authorized Official - Last Name:PAVEHZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-367-9068
Mailing Address - Street 1:12737 GLENOAKS BLVD
Mailing Address - Street 2:SUITE 12A
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-367-9068
Mailing Address - Fax:818-367-9069
Practice Address - Street 1:12737 GLENOAKS BLVD
Practice Address - Street 2:SUITE 12A
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-367-9068
Practice Address - Fax:818-367-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7940103T00000X
CADC29084111N00000X
CAAC11667173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29084Medicare PIN