Provider Demographics
NPI:1750641080
Name:RAUL ARTURO PARDAVE, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAUL ARTURO PARDAVE, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARDAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-545-7418
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:1530 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4163
Practice Address - Country:US
Practice Address - Phone:818-545-7418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAUL ARTURO PARDAVE, MD, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-21
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site