Provider Demographics
NPI:1073643540
Name:MEDICAL AYURVEDA REJUVENATION CENTER A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MEDICAL AYURVEDA REJUVENATION CENTER A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-4566
Mailing Address - Street 1:355 PLACENTIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3311
Mailing Address - Country:US
Mailing Address - Phone:949-644-4566
Mailing Address - Fax:949-644-2991
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3311
Practice Address - Country:US
Practice Address - Phone:949-644-4566
Practice Address - Fax:949-644-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service