Provider Demographics
NPI:1306444971
Name:RAVONKAVI SERVICES
Entity type:Organization
Organization Name:RAVONKAVI SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHRI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-391-7790
Mailing Address - Street 1:32732 BALLENA
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4157
Mailing Address - Country:US
Mailing Address - Phone:949-436-2127
Mailing Address - Fax:
Practice Address - Street 1:23331 EL TORO RD STE 208
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4883
Practice Address - Country:US
Practice Address - Phone:949-391-7790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285972257OtherNPI