| Indravadan A Dave Md Inc | |
|
274 One And Half S Rampart Blvd Los Angeles CA 90057-1404 | |
| (213) 389-5570 | |
| (213) 389-5578 |
| Full Name | Indravadan A Dave Md Inc |
|---|---|
| Speciality | General Practice |
| Location | 274 One And Half S Rampart Blvd, Los Angeles, California |
| Authorized Official Name and Position | Indravadan A Dave (OWNER PRES) |
| Authorized Official Contact | 2133895570 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indravadan A Dave Md Inc 274 One And Half S Rampart Blvd Los Angeles CA 90057-1404 Ph: (213) 389-5570 | Indravadan A Dave Md Inc 274 One And Half S Rampart Blvd Los Angeles CA 90057-1404 Ph: (213) 389-5570 |
| NPI Number | 1609916048 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609916048 | NPI | - | NPPES |
| C41876 | Other | CA | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | C41876 (California) | Primary |
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