Provider Demographics
NPI:1568121887
Name:SEPULVEDA OPTIMAL HEALTH CARE INC
Entity Type:Organization
Organization Name:SEPULVEDA OPTIMAL HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANDISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-836-0608
Mailing Address - Street 1:15243 VANOWEN ST STE 403
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3611
Mailing Address - Country:US
Mailing Address - Phone:818-836-0608
Mailing Address - Fax:
Practice Address - Street 1:15243 VANOWEN ST STE 403
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3611
Practice Address - Country:US
Practice Address - Phone:818-836-0608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC168905OtherMEDICAL BOARD OF CALIFORNIA