Provider Demographics
NPI:1427720549
Name:PADIA, PRAVAY
Entity type:Individual
Prefix:DR
First Name:PRAVAY
Middle Name:
Last Name:PADIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 VIA ARBOLADA UNIT 321
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5124
Mailing Address - Country:US
Mailing Address - Phone:626-780-0397
Mailing Address - Fax:
Practice Address - Street 1:12271 LA MIRADA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1336
Practice Address - Country:US
Practice Address - Phone:626-780-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1070161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice