Avanta Medical Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

AVANTA MEDICAL GROUP

Practice address

14649 Victory Blvd Ste 22
Van Nuys, CA 91411-4101

Phone

(818) 796-5558

NPI assigned

Apr 27, 2026

Organization subpart

No

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

Authorized official

Name

Vyacheslav Davtian

Title

Ceo

Phone

(818) 796-5558

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen Pine, M.D.

  • Obstetrics & Gynecology Physician
  • Los Angeles, CA
  • NPI 1356352108
  Medicare reassignment

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

{
    "created_epoch": "1777248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1770429102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14649 VICTORY BLVD STE 22",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914114101",
            "telephone_number": "818-796-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14649 VICTORY BLVD STE 22",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914114101",
            "telephone_number": "818-796-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-27",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "DAVTIAN",
        "authorized_official_first_name": "VYACHESLAV",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-796-5558"
    },
    "taxonomies": [
        {
            "code": "163WI0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Pain Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autism Movement Therapy, Inc. (Autism Movement Therapy)
• Autism Respond Team, Inc.
• Auxiliary Home Health Care
• Karla Avalos
• Avan Wellness Center
• Avante Diagnostic Laboratory LLC (Avante Diagnostic Laboratory)
• Avanti Transportation Services, LLC
• Sevada Avartzarian
• Ave Hospice Care, Inc.
• Ave Maria Home Health Inc

• General Practice Physician in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.