Provider Demographics
NPI:1316990070
Name:ITCHHAPORIA, DIPTI (MD)
Entity type:Individual
Prefix:
First Name:DIPTI
Middle Name:
Last Name:ITCHHAPORIA
Suffix:
Gender:F
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:PO BOX 3696
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8696
Mailing Address - Country:US
Mailing Address - Phone:949-548-6634
Mailing Address - Fax:949-548-1431
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-548-6634
Practice Address - Fax:949-548-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66492207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01634Medicare UPIN
G66492Medicare ID - Type Unspecified