Provider Demographics
NPI:1699924019
Name:GLENWEST MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:GLENWEST MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-243-1186
Mailing Address - Street 1:8719 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-4729
Mailing Address - Country:US
Mailing Address - Phone:818-920-1232
Mailing Address - Fax:
Practice Address - Street 1:8719 WOODLEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-4729
Practice Address - Country:US
Practice Address - Phone:818-920-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty