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Organization
MEDWISE MEDICAL CLINIC, INC
Active
Organization
MEDWISE MEDICAL CLINIC, INC
Active
Other names
MEDWISE MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHALIMAN EIVAZZADEH M.D. (OWNER)
(818) 242-0500
Entity
Organization
Contact information
Practice address
540 N CENTRAL AVE, SUITE 203, GLENDALE, CA 91203-1916
(818) 242-0500
Mailing address
PO BOX 601, GLENDALE, CA 91209-0601
(818) 242-0500
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A42072
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A420721
—
CA
Enumeration date
06/02/2006
Last updated
08/22/2020
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