Provider Demographics
NPI:1538992540
Name:EVOLVE ANTI-AGING & WELLNESS CENTER
Entity type:Organization
Organization Name:EVOLVE ANTI-AGING & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGHIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-606-2459
Mailing Address - Street 1:16500 VENTURA BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2062
Mailing Address - Country:US
Mailing Address - Phone:818-600-7600
Mailing Address - Fax:818-334-2497
Practice Address - Street 1:16500 VENTURA BLVD STE 420
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2062
Practice Address - Country:US
Practice Address - Phone:818-600-7600
Practice Address - Fax:818-334-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy