1447506779 NPI number — PREETI VISHAL KUMAR ADESHARA M.B.B.S.

Table of content: PREETI VISHAL KUMAR ADESHARA M.B.B.S. (NPI 1447506779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447506779 NPI number — PREETI VISHAL KUMAR ADESHARA M.B.B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADESHARA
Provider First Name:
PREETI
Provider Middle Name:
VISHAL KUMAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S.
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:
1447506779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92324-0822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-549-0900
Provider Business Mailing Address Fax Number:
951-278-2848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2071 COMPTON AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-549-0900
Provider Business Practice Location Address Fax Number:
951-278-2848
Provider Enumeration Date:
07/24/2012

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: 207Q00000X , with the licence number:  133972 , 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)





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