Provider Demographics
NPI:1992038285
Name:ABSOLUTE HEALTH MEDICAL SPA
Entity Type:Organization
Organization Name:ABSOLUTE HEALTH MEDICAL SPA
Other - Org Name:ABSOLUTE HEALTH & ANTI AGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-864-0189
Mailing Address - Street 1:4820 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1696
Mailing Address - Country:US
Mailing Address - Phone:707-864-0189
Mailing Address - Fax:707-864-0190
Practice Address - Street 1:4820 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1696
Practice Address - Country:US
Practice Address - Phone:707-864-0189
Practice Address - Fax:707-864-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty