Healthcare Provider Details

I. General information

NPI: 1902141385
Provider Name (Legal Business Name): PRAVESH THAPAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12059 DELANTE WAY
GRANADA HILLS CA
91344-2141
US

IV. Provider business mailing address

12059 DELANTE WAY
GRANADA HILLS CA
91344-2141
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-6461
  • Fax: 818-700-2480
Mailing address:
  • Phone: 818-832-6461
  • Fax: 818-700-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: