Provider Demographics
NPI:1063515971
Name:PRAVIN KAPADIA MD. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PRAVIN KAPADIA MD. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAPADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-864-4004
Mailing Address - Street 1:13330 BLOOMFIELD AVE
Mailing Address - Street 2:# 210
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3251
Mailing Address - Country:US
Mailing Address - Phone:562-864-4004
Mailing Address - Fax:562-864-4959
Practice Address - Street 1:13330 BLOOMFIELD AVE
Practice Address - Street 2:# 210
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3266
Practice Address - Country:US
Practice Address - Phone:562-864-4004
Practice Address - Fax:562-864-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26316Medicare UPIN