1548239338 NPI number — PRABHJIT S. PUREWAL, MD, INC.

Table of content: (NPI 1548239338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548239338 NPI number — PRABHJIT S. PUREWAL, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRABHJIT S. PUREWAL, MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1548239338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7935
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95267-0935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-823-0000
Provider Business Mailing Address Fax Number:
209-824-1449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 ST. DOMINIC'S DR
Provider Second Line Business Practice Location Address:
STE 120, 140
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95337-7802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-823-0000
Provider Business Practice Location Address Fax Number:
209-824-1449
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PUREWAL
Authorized Official First Name:
PRABHJIT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
209-823-0000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A48423 , 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: ZZZ06721Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ23785Z . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A484230 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A484231 . This is a "MEDI CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A484230 . This is a "MEDICARE ID -TYPE UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ65255Y . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ65256Y . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DA3789 . This is a "RAILRODA MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00023054 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ65257Y . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ66761Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com