Provider Demographics
NPI:1013071539
Name:AUSTIN & VATAVE MD'S INC.
Entity type:Organization
Organization Name:AUSTIN & VATAVE MD'S INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUBHANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:GODBOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-944-8054
Mailing Address - Street 1:12675 LA MIRADA BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2200
Mailing Address - Country:US
Mailing Address - Phone:562-944-8054
Mailing Address - Fax:562-946-5324
Practice Address - Street 1:12675 LA MIRADA BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2200
Practice Address - Country:US
Practice Address - Phone:562-944-8054
Practice Address - Fax:562-946-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty