# MEDWISE MEDICAL CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDWISE MEDICAL CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609813096
- **Authorized official:** DR. SHALIMAN EIVAZZADEH M.D. (OWNER)
- **Authorized official phone:** (818) 242-0500

## Contact information

- **Practice address:** 540 N CENTRAL AVE, SUITE 203, GLENDALE, CA 91203-1916
- **Practice address phone:** (818) 242-0500
- **Mailing address:** PO BOX 601, GLENDALE, CA 91209-0601
- **Mailing address phone:** (818) 242-0500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A42072 | CA | Yes |

## Other

- **Enumeration date:** 06/02/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A420721 | — | CA |