Via Avanta
Clinic/Center, Community Health in Culver City, CA. Organization (NPI-2).
NPI number1639610462
StatusActive
Last updated in NPPESMar 13, 2017
Details
- NPI
- 1639610462
- Entity type
- Organization (NPI-2)
- Legal business name
- Via Avanta
- Organization subpart
- No
- Enumeration date
- Mar 13, 2017
- Last updated
- Mar 13, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QC1500X | Clinic/Center, Community Health | 172V00000X | CA | Yes |
Practice location
4760 Sepulveda BlvdCulver City, CA 90230
Phone 310-390-6612
Mailing address
4760 Sepulveda BlvdCulver City, CA 90230
Phone 310-390-6612
Authorized official
Mayli Eunice Torres
Assistant Counsler
8185619415
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