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Organization
AVANTA MEDICAL GROUP
Active
Organization
AVANTA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VYACHESLAV DAVTIAN (CEO)
(818) 796-5558
Entity
Organization
Contact information
Practice address
14649 VICTORY BLVD STE 22, VAN NUYS, CA 91411-4101
(818) 796-5558
Mailing address
14649 VICTORY BLVD STE 22, VAN NUYS, CA 91411-4101
(818) 796-5558
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
—
—
163WP0000X
Pain Management Registered Nurse
—
—
208D00000X
General Practice Physician
Primary
—
—
213E00000X
Podiatrist
—
—
Other
Enumeration date
04/27/2026
Last updated
04/27/2026
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