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General NPI Number Information
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NPI Number | 1972937266
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Entity Type | Organization
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Legal Business Name | SPN MEDICAL CONSULTING INC.
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 520 SUPERIOR AVE STE. 350
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3637
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Country | US
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Telephone | 949-650-0616
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Fax | 949-650-0600
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Provider Business Mailing Address
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Address Line | 520 SUPERIOR AVE STE. 350
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3637
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Country | US
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Telephone | 949-650-0616
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Fax | 949-650-0600
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Authorized Official
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Title or Position | OWNER
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Name | SEAN P. NIKRAVAN
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Credential | M.D.
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Telephone | 714-366-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A80371
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License Number State | CA
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