Healthcare Provider Details

I. General information

NPI: 1790861490
Provider Name (Legal Business Name): VIMALI PAUL, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 DECLARATION DR SUITE 110
CHICO CA
95973-4902
US

IV. Provider business mailing address

85 DECLARATION DR SUITE 110
CHICO CA
95973-4902
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-6600
  • Fax: 530-894-1321
Mailing address:
  • Phone: 530-894-6600
  • Fax: 530-894-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA53520
License Number StateCA

VIII. Authorized Official

Name: VIMALI PAUL
Title or Position: MD, CEO
Credential: MD
Phone: 530-894-6600