Provision Medical Group Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

PROVISION MEDICAL GROUP INC

Practice address

19702 Skyview CT
Santa Clarita, CA 91351-6900

Phone

(661) 383-3477

NPI assigned

Sep 8, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Junaida Shakhvaladyan

Title

Ceo

Phone

(661) 383-3477

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1788825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788825600000",
    "number": "1265342703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19702 SKYVIEW CT",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913516900",
            "telephone_number": "661-383-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19702 SKYVIEW CT",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913516900",
            "telephone_number": "661-383-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-08",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A",
        "authorized_official_last_name": "SHAKHVALADYAN",
        "authorized_official_first_name": "JUNAIDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-383-3477"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.