=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023773470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VANOWEN OPTIMAL HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2021
-----------------------------------------------------
Last Update Date | 11/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15243 VANOWEN ST STE 403
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-836-0608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15243 VANOWEN ST STE 403
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-836-0608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAVI SINGH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-850-9297
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------