# VIA AVANTA

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

## Provider details

- **NPI number:** 1639610462
- **Authorized official:** MAYLI EUNICE TORRES (ASSISTANT COUNSLER)
- **Authorized official phone:** (818) 561-9415

## Contact information

- **Practice address:** 4760 SEPULVEDA BLVD, CULVER CITY, CA 90230
- **Practice address phone:** (310) 390-6612
- **Mailing address:** 4760 SEPULVEDA BLVD, CULVER CITY, CA 90230
- **Mailing address phone:** (310) 390-6612

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 172V00000X | CA | Yes |

## Other

- **Enumeration date:** 03/13/2017
- **Last updated:** 03/13/2017