NPIMap

Organization Active NPI

Mid Valley Vascular Center, Inc

  • Multi-Specialty Clinic/Center
  • Reseda, CA
National Provider Identifier
1790187169
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MID VALLEY VASCULAR CENTER, INC
Practice address
7640 Tampa Ave
Suite 101a
Reseda, CA 91335-1735
Phone
(818) 718-1600
Fax
(818) 343-1612
NPI assigned
Sep 17, 2014
Last updated
Nov 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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

Authorized official

Name
Dr. Leo Polosajian, MDNPI 1174664783
Title
President/Ceo
Phone
(818) 454-3638

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

7640 Tampa Ave
Suite 101a
Reseda, CA 91335-1735

Mailing address

4930 Balboa Blvd
Suite 261278
Encino, CA 91426-7001
Phone (818) 718-1600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141111001439 CA Part B Supplier - Clinic/Group Practice 5395967186 Receives reassigned benefits from 7 practitioners
Practice locations: Reseda, CA

National Provider Directory

National Provider Directory

Locations

4930 Balboa Blvd
Unit 261278
Encino, CA 91426

7640 Tampa Ave
Ste 101A
Reseda, CA 91335
Phone (818) 718-1600

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415145600000",
    "number": "1790187169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 BALBOA BLVD",
            "address_2": "SUITE 261278",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914267001",
            "telephone_number": "818-718-1600",
            "fax_number": "818-343-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7640 TAMPA AVE",
            "address_2": "SUITE 101A",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913351735",
            "telephone_number": "818-718-1600",
            "fax_number": "818-343-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID VALLEY VASCULAR CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-11-05",
        "status": "A",
        "authorized_official_last_name": "POLOSAJIAN",
        "authorized_official_first_name": "LEO",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "818-454-3638",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reseda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; 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.