Provider Demographics
NPI:1245436690
Name:VALLEY ENDOCRINE & DIABETES CONSULTANTS
Entity type:Organization
Organization Name:VALLEY ENDOCRINE & DIABETES CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:
Authorized Official - Last Name:MACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-239-0288
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:225
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-239-0288
Mailing Address - Fax:818-239-0289
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:225
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-239-0288
Practice Address - Fax:818-239-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAO5D1053414291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831298736Medicaid