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General NPI Number Information
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NPI Number | 1750431789
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Entity Type | Individual
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Provider Name | ROYA MANAVI-MAKHANI OPTOMETRIST
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 1312 MONTANA AVE.
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City | LOS ANGELES
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State | CA
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Zip | 90403
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Country | US
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Telephone | 131-057-6919
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Fax | 131-065-6685
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Provider Business Mailing Address
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Address Line | 12901 BENVENUE ST
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City | LOS ANGELES
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State | CA
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Zip | 90049-4821
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Country | US
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Telephone | 131-045-1220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10510T
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License Number State | CA
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