Provider Demographics
NPI:1972937266
Name:SPN MEDICAL CONSULTING INC.
Entity type:Organization
Organization Name:SPN MEDICAL CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NIKRAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-366-4766
Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:STE. 350
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-650-0616
Mailing Address - Fax:949-650-0600
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:STE. 350
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-650-0616
Practice Address - Fax:949-650-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80371207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty