Basic Information
| Provider Information | |||||||||
| NPI: | 1922762806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VITAL LUNGS ASSOCIATES OF SOUTHERN CALIFORNIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22543 VENTURA BLVD UNIT 220-117 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913641412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263756431 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18300 ROSCOE BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913254105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188858500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | ATABAKI | ||||||||
| AuthorizedOfficialFirstName: | ALI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6263756431 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.