Healthylife MG Corp
Organization Active NPI Family Medicine Physician · La Canada, CA
NPI 1184489684 · NPPES record last updated Jul 9, 2024
Key facts
- NPI
- 1184489684
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- HEALTHYLIFE MG CORP
- Practice address
- 245 Berkshire Ave
La Canada, CA 91011-4017 - Phone
- (818) 361-5437
- NPI assigned
- Feb 14, 2024
- Organization subpart
- No
Authorized official
- Name
- Monessa Azad
- Title
- Credentialing
- Phone
- (818) 361-5437
Practitioners 22
-
Benjamin Behroozan, M.D.
-
Janesri W De Silva, M.D.
-
Faiza Iram, MD
-
Yussef Sakhai, MD
-
Jasmine Ahdout Berookim, M.D.
-
Cecilio V. Cay, NP
-
Mario Cuevas, PAC
-
Oscar A Escobar, PA-C
-
Ruth Gabay, FNP-C
-
Clarissa A Gooze, FNP
-
Helen Pensanti, MD
-
David Farahmand Razi, M.D.
-
Trish Balolong Reyes, NURSE PRACTITIONER
-
Alea Nicole Sohn, FNP, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241011002290 | CA | Part B Supplier - Clinic/Group Practice | 8224560578 |
Receives reassigned benefits from 5 practitioners Practice locations: Los Angeles, CA |
National Provider Directory
Locations
2221 Lincoln Blvd
Santa Monica, CA 90405
Phone (818) 308-4100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
245 Berkshire Ave
La Canada, CA 91011-4017
Mailing address
245 Berkshire Ave
La Canada, CA 91011-4017
Phone (818) 361-5437
Other names
- St Gianna Medical Group
Other providers in La Canada, CA
- Eli William Hallak
- Farhad Hamidi
- Christine Hanna
- Clifford Thomas Hartman Jr.
- Hillary Lynne Haynes
- Sokunthear Hem
- Christopher John Henry
- Brandon Ho
- Kenneth Chiang Ho
- John Arthur Honch
All providers in La Canada, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.