Organization
AVANTI HOME DOCTORS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALLACE TUPAS GOODWIN III (COORDINATOR)
(818) 437-5848
Entity
Organization
Contact information
Practice address
17050 CHATSWORTH ST STE 253, GRANADA HILLS, CA 91344-5897
(818) 437-5848
Mailing address
17050 CHATSWORTH ST STE 253, GRANADA HILLS, CA 91344-5897
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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