# AMIGO INDUSTRIAL MEDICAL GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1760676563
- **Authorized official:** DR. ROBERE J MISSIRIAN MD (PRESIDENT)
- **Authorized official phone:** (818) 759-2555

## Contact information

- **Practice address:** 6801 COLDWATER CANYON AVE STE 1E, NORTH HOLLYWOOD, CA 91605-5167
- **Practice address phone:** (818) 759-2555
- **Mailing address:** 13029A VICTORY BLVD \# 525, NORTH HOLLYWOOD, CA 91606-2925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G84264 | CA | Yes |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | G84264 | CA | — |
| 208U00000X | Clinical Pharmacology Physician | G84264 | CA | — |

## Other

- **Enumeration date:** 09/05/2007
- **Last updated:** 09/05/2007