# BELLA VISTA MEDICAL GROUP IPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093844656
- **Authorized official:** MS. LINDA DEAKTOR R.N. (DIRECTOR OF MEDICAL AFFAIRS)
- **Authorized official phone:** (818) 702-0100

## Contact information

- **Practice address:** 6400 CANOGA AVE, SUITE 163, WOODLAND HILLS, CA 91367-2425
- **Practice address phone:** (818) 702-0100
- **Practice address fax:** (818) 702-9128
- **Mailing address:** PO BOX 572066, TARZANA, CA 91357-2066
- **Mailing address phone:** (818) 702-0100
- **Mailing address fax:** (818) 702-9128

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 03/02/2007
- **Last updated:** 08/22/2020