1306917133 NPI number — DR. SAPAN NARESH PALKHIWALA D.P.T.

Table of content: DR. SAPAN NARESH PALKHIWALA D.P.T. (NPI 1306917133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306917133 NPI number — DR. SAPAN NARESH PALKHIWALA D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALKHIWALA
Provider First Name:
SAPAN
Provider Middle Name:
NARESH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
M

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:
1306917133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24422 AVENIDA DE LA CARLOTA
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-7602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-340-6927
Provider Business Mailing Address Fax Number:
949-215-7246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24422 AVENIDA DE LA CARLOTA
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-7602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-340-6927
Provider Business Practice Location Address Fax Number:
949-215-7246
Provider Enumeration Date:
11/13/2006

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: 2251G0304X , with the licence number:  PT26543 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WPT26543A . This is a "PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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