Healthcare Provider Details

I. General information

NPI: 1497026439
Provider Name (Legal Business Name): VISHWA KAPOOR,M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 2280 A
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 Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA41870
License Number StateCA

VIII. Authorized Official

Name: DR. VISHWA M KAPOOR
Title or Position: CEO
Credential: MD
Phone: 760-604-2714