Healthcare Provider Details

I. General information

NPI: 1538604822
Provider Name (Legal Business Name): RAVISH PRAJAPATI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S ORANGE AVE
EL CAJON CA
92020-7521
US

IV. Provider business mailing address

PO BOX 7410882
CHICAGO IL
60674-0882
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020488
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: