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Organization
SOUTH VALLEY INTERNAL MEDICINE A MEDICAL CORPORATION
Active
Organization
SOUTH VALLEY INTERNAL MEDICINE A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENIA VILLALBA (PRACTIVE MANGER)
(626) 397-4910
Entity
Organization
Contact information
Practice address
18356 CLARK ST, SUITE 101, TARZANA, CA 91356-3502
(626) 397-4910
(626) 397-4911
Mailing address
540 S MARENGO AVE, PASADENA, CA 91101-3130
(626) 397-4910
(626) 397-4911
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A67014
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A670140
—
CA
01
—
607841115
SS#
CA
Enumeration date
02/08/2006
Last updated
04/29/2008
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