Professional Minds, PC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

PROFESSIONAL MINDS, PC

Practice address

19234 Vanowen St
Reseda, CA 91335-5000

Phone

(818) 638-3123

NPI assigned

Oct 22, 2012

Organization subpart

Yes

Parent organization

PROFESSIONAL MINDS, PCAs reported in NPPES

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

Authorized official

Name

Dr. Ariel M. Gavino, MD

Title

President

Phone

(818) 638-3123

Specialties & licenses 1

Addresses

Part of

Professional Minds PC

Locations

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1699028076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-474-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19234 VANOWEN ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913355000",
            "telephone_number": "818-638-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL MINDS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFESSIONAL MINDS, PC",
        "enumeration_date": "2012-10-22",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "GAVINO",
        "authorized_official_first_name": "ARIEL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-638-3123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Non-Pharmacy Dispensing Site in Reseda, CA
• Providers in Reseda, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.