Organization
CASPIAN MEDICAL CLINIC, CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAX MAHMOUD GHANNADI M.D., (OWNER)
(818) 994-0000
Entity
Organization
Contact information
Practice address
14103 VICTORY BLVD, SUITE 7, VAN NUYS, CA 91401-1998
(818) 994-0000
(818) 988-2949
Mailing address
14103 VICTORY BLVD, SUITE 7, VAN NUYS, CA 91401-1998
(818) 994-0000
(818) 988-2949
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A102618
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A102618
LICENSE
CA
Enumeration date
08/19/2009
Last updated
09/23/2010
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