1194093229 NPI number — NIVA INSTITUTE OF NEUROSCIENCES, INC.,

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194093229 NPI number — NIVA INSTITUTE OF NEUROSCIENCES, INC.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIVA INSTITUTE OF NEUROSCIENCES, INC.,
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:
6
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:
1194093229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15963 QUANTICO RD
Provider Second Line Business Mailing Address:
SUITE C,
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92307-0839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-242-4810
Provider Business Mailing Address Fax Number:
760-242-4760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15963 QUANTICO RD
Provider Second Line Business Practice Location Address:
SUITE C,
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-0839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-4810
Provider Business Practice Location Address Fax Number:
760-242-4760
Provider Enumeration Date:
12/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
RAVI
Authorized Official Middle Name:
ASHOK
Authorized Official Title or Position:
CEO AND PRESIDENT
Authorized Official Telephone Number:
760-242-4810

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  A115902 , 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)





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