Provider Demographics
NPI:1215350327
Name:JEEVA LLC
Entity type:Organization
Organization Name:JEEVA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:GOVIND
Authorized Official - Last Name:GHANEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-500-2517
Mailing Address - Street 1:501 W GLENOAKS BLVD
Mailing Address - Street 2:SUITE#12
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2896
Mailing Address - Country:US
Mailing Address - Phone:818-500-1517
Mailing Address - Fax:818-500-1519
Practice Address - Street 1:501 W GLENOAKS BLVD STE 12
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4041
Practice Address - Country:US
Practice Address - Phone:818-500-1517
Practice Address - Fax:818-500-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY51730333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7086350001Medicare NSC