Provider Demographics
NPI:1003138694
Name:RAVI PANJABI, M.D., INC.
Entity Type:Organization
Organization Name:RAVI PANJABI, M.D., INC.
Other - Org Name:ADVANCED PAIN MANAGEMENT & REHAB MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PANJABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-582-8555
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR STE 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1735
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:19850 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4002
Practice Address - Country:US
Practice Address - Phone:510-582-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAVI PANJABI, M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-23
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55600332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site