Provider Demographics
NPI:1871519934
Name:DAVE, RAVI HARSHAD (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:HARSHAD
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2124
Practice Address - Country:US
Practice Address - Phone:310-582-6220
Practice Address - Fax:310-582-6222
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53150207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A531500Medicaid
CA00A531500Medicaid
CAWA53150LMedicare PIN
CABG108Medicare PIN
CAWA53150HMedicare PIN
CAWA53150JMedicare PIN
CAWA53150IMedicare PIN