Organization
MEDWISE MEDICAL CLINIC, INC
Active
Other names
MEDWISE MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHALIMAN EIVAZZADEH M.D. (OWNER)
(818) 242-0500
Entity
Organization
Contact information
Practice address
540 N CENTRAL AVE, SUITE 203, GLENDALE, CA 91203-1916
(818) 242-0500
Mailing address
PO BOX 601, GLENDALE, CA 91209-0601
(818) 242-0500
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A42072
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A420721
—
CA
Enumeration date
06/02/2006
Last updated
08/22/2020
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