Provider Demographics
NPI:1669006490
Name:PV HEALTHCARE CORP
Entity Type:Organization
Organization Name:PV HEALTHCARE CORP
Other - Org Name:VALENCIA MEDICAL SPA AND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMELLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-429-4188
Mailing Address - Street 1:23817 GARLAND CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 120
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5085
Practice Address - Country:US
Practice Address - Phone:661-282-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty