Provider Demographics
NPI:1649686684
Name:NIVANO CARE MEDICAL GROUP INC
Entity type:Organization
Organization Name:NIVANO CARE MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VENU
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-300-3074
Mailing Address - Street 1:3229 CAMINITO AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-9705
Mailing Address - Country:US
Mailing Address - Phone:530-300-3074
Mailing Address - Fax:
Practice Address - Street 1:729 SUNRISE AVE STE 601
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4542
Practice Address - Country:US
Practice Address - Phone:916-783-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102853207R00000X
CAA73939207RN0300X
CAC55196364SF0001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty