| Mona Lisa Medical Group, Inc | |
|
14856 Vanowen St Van Nuys CA 91405-3828 | |
| (818) 281-3935 | |
| Not Available |
| Full Name | Mona Lisa Medical Group, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14856 Vanowen St, Van Nuys, California |
| Authorized Official Name and Position | Alva Marsh (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 8182813935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mona Lisa Medical Group, Inc 14856 Vanowen St Van Nuys CA 91405-3828 Ph: (818) 281-3935 | Mona Lisa Medical Group, Inc 14856 Vanowen St Van Nuys CA 91405-3828 Ph: (818) 281-3935 |
| NPI Number | 1447909106 |
|---|---|
| Provider Enumeration Date | 03/21/2022 |
| Last Update Date | 03/21/2022 |
| Medicare PECOS PAC ID | 6709268519 |
|---|---|
| Medicare Enrollment ID | O20220726002616 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447909106 | NPI | - | NPPES |
| C22547 | Other | CA | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Alva A Marsh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619036621 PECOS PAC ID: 3173805488 Enrollment ID: I20170127002374 |
| Provider Name | Lilith Garibyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003526724 PECOS PAC ID: 6406211176 Enrollment ID: I20230502002211 |
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