Basic Information
| Provider Information | |||||||||
| NPI: | 1972937266 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPN MEDICAL CONSULTING INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 SUPERIOR AVE | ||||||||
| Address2: | STE. 350 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926633637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496500616 | ||||||||
| FaxNumber: | 9496500600 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 SUPERIOR AVE | ||||||||
| Address2: | STE. 350 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926633637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496500616 | ||||||||
| FaxNumber: | 9496500600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2013 | ||||||||
| LastUpdateDate: | 03/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | NIKRAVAN | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7143664766 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | A80371 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.