Provider Demographics
NPI:1568819415
Name:NITI V. PERUVEMBA, D.O., INC.
Entity Type:Organization
Organization Name:NITI V. PERUVEMBA, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NITI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-707-0290
Mailing Address - Street 1:32144 AGOURA RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4031
Mailing Address - Country:US
Mailing Address - Phone:818-707-0290
Mailing Address - Fax:818-707-0291
Practice Address - Street 1:32144 AGOURA RD
Practice Address - Street 2:SUITE 118
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4031
Practice Address - Country:US
Practice Address - Phone:818-707-0290
Practice Address - Fax:888-431-8819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NITI V. PERUVEMBA, D.O., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-20
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8826332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site