Healthcare Provider Details

I. General information

NPI: 1275796633
Provider Name (Legal Business Name): KALLE VARAV MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 APTOS RANCHO RD #A
APTOS CA
95003-3983
US

IV. Provider business mailing address

PO BOX 6406
SANTA MARIA CA
93456-6406
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-1731
  • Fax: 805-349-8160
Mailing address:
  • Phone: 805-928-1731
  • Fax: 805-349-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA61783
License Number StateCA

VIII. Authorized Official

Name: TRACY MORENO
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-928-1731