Provider Demographics
NPI:1194093229
Name:NIVA INSTITUTE OF NEUROSCIENCES, INC.,
Entity type:Organization
Organization Name:NIVA INSTITUTE OF NEUROSCIENCES, INC.,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, FACP, FAHA
Authorized Official - Phone:760-242-4810
Mailing Address - Street 1:15963 QUANTICO RD
Mailing Address - Street 2:SUITE C,
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0839
Mailing Address - Country:US
Mailing Address - Phone:760-242-4810
Mailing Address - Fax:760-242-4760
Practice Address - Street 1:15963 QUANTICO RD
Practice Address - Street 2:SUITE C,
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-0839
Practice Address - Country:US
Practice Address - Phone:760-242-4810
Practice Address - Fax:760-242-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1159022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY693AMedicare PIN