1114053451 NPI number — DR. URVI PAJVANI GONZALES M.D.

Table of content: DR. URVI PAJVANI GONZALES M.D. (NPI 1114053451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114053451 NPI number — DR. URVI PAJVANI GONZALES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALES
Provider First Name:
URVI
Provider Middle Name:
PAJVANI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114053451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 MICHIGAN AVE NE
Provider Second Line Business Mailing Address:
APT F33
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20017-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-744-9340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 19TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20036-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-955-6995
Provider Business Practice Location Address Fax Number:
202-955-3915
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  125051643 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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