Healthcare Provider Details

I. General information

NPI: 1790041770
Provider Name (Legal Business Name): SHAHRAM F. RAVAN,M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR SUITE 214
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

436 N BEDFORD DR SUITE 214
BEVERLY HILLS CA
90210-4310
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-9200
  • Fax: 310-271-3793
Mailing address:
  • Phone: 310-858-9200
  • Fax: 310-271-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA40168
License Number StateCA

VIII. Authorized Official

Name: DR. SHAHRAM FRANCIOS RAVAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-858-9200