Provider Demographics
NPI:1548638596
Name:IV FOR LIFE
Entity type:Organization
Organization Name:IV FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOGDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-290-9668
Mailing Address - Street 1:2973 HARBOR BLVD
Mailing Address - Street 2:BOX 322
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3912
Mailing Address - Country:US
Mailing Address - Phone:510-290-9668
Mailing Address - Fax:714-908-7953
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2815
Practice Address - Country:US
Practice Address - Phone:510-290-9668
Practice Address - Fax:714-908-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60996261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy