Healthcare Provider Details

I. General information

NPI: 1942239892
Provider Name (Legal Business Name): VISHWA MOHINI KAPOOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 S IMPERIAL AVE SUITE A
EL CENTRO CA
92243-4243
US

IV. Provider business mailing address

PO BOX 2280
EL CENTRO CA
92244-2280
US

V. Phone/Fax

Practice location:
  • Phone: 760-604-2714
  • Fax: 760-344-7106
Mailing address:
  • Phone: 760-604-2714
  • Fax: 760-344-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00A418700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: