Provider Demographics
NPI:1811410046
Name:DRV MEDICAL INC
Entity Type:Organization
Organization Name:DRV MEDICAL INC
Other - Org Name:DRV MEDICAL INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOPPANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VISNYEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-651-9017
Mailing Address - Street 1:5901 W OLYMPIC BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4669
Mailing Address - Country:US
Mailing Address - Phone:310-651-9017
Mailing Address - Fax:323-954-1081
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4669
Practice Address - Country:US
Practice Address - Phone:310-651-9017
Practice Address - Fax:323-954-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center