Avanta Medical Group
General Practice in Van Nuys, CA. Organization (NPI-2).
NPI number1770429102
StatusActive
Last updated in NPPESApr 27, 2026
Details
- NPI
- 1770429102
- Entity type
- Organization (NPI-2)
- Legal business name
- Avanta Medical Group
- Organization subpart
- No
- Enumeration date
- Apr 27, 2026
- Certification date
- Apr 27, 2026
- Last updated
- Apr 27, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
| 163WI0500X | Registered Nurse, Infusion Therapy | – | – | |
| 163WP0000X | Registered Nurse, Pain Management | – | – | |
| 213E00000X | Podiatrist | – | – |
Practice location
14649 Victory Blvd Ste 22Van Nuys, CA 91411-4101
Phone 818-796-5558
Mailing address
14649 Victory Blvd Ste 22Van Nuys, CA 91411-4101
Phone 818-796-5558
Authorized official
Vyacheslav Davtian
Ceo
8187965558
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