Provider Demographics
NPI:1194889410
Name:BANSAL, VISHAL (MD)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WASHINGTON ST STE 641
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2229
Mailing Address - Country:US
Mailing Address - Phone:619-298-3100
Mailing Address - Fax:619-299-3923
Practice Address - Street 1:550 WASHINGTON ST STE 641
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2229
Practice Address - Country:US
Practice Address - Phone:619-298-3100
Practice Address - Fax:619-299-3923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94958208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery