Provider Demographics
NPI:1497131023
Name:CAVENDER MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CAVENDER MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-939-9557
Mailing Address - Street 1:361 HOSPITAL RD STE 521
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3526
Mailing Address - Country:US
Mailing Address - Phone:949-939-9557
Mailing Address - Fax:
Practice Address - Street 1:361 HOSPITAL RD STE 521
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3526
Practice Address - Country:US
Practice Address - Phone:949-939-9557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care