Healthcare Provider Details

I. General information

NPI: 1609222546
Provider Name (Legal Business Name): NIVIN PORWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38690 STIVERS ST STE A
FREMONT CA
94536-5276
US

IV. Provider business mailing address

38590 STIVERS ST, SUITE A
FREMONT CA
94536
US

V. Phone/Fax

Practice location:
  • Phone: 614-256-1951
  • Fax:
Mailing address:
  • Phone: 614-256-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number18913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: