=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366655516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAVA INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 11/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1197 E ARQUES AVE
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94085-3904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-451-0335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 OLCOTT ST
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-451-0335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MANOCHEHR POURANSARI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-731-8686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 070000655
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------