1013068162 NPI number — AVINASH M. MONDKAR M.D.,A MEDICAL CORPORATION

Table of content: (NPI 1013068162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013068162 NPI number — AVINASH M. MONDKAR M.D.,A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVINASH M. MONDKAR M.D.,A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013068162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8641 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
#220
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-657-1995
Provider Business Mailing Address Fax Number:
310-657-5311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1041 N CHINA LAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-657-1995
Provider Business Practice Location Address Fax Number:
310-657-5311
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONDKAR
Authorized Official First Name:
AVINASH
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-657-1995

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A35142 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A351420 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00736288 . This is a "PALMETTO GBA MEDICARE/NORTHERN CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 756063687 . This is a "PALMETTO GBA MEDICARE/SOUTHERN CA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com