Healthcare Provider Details

I. General information

NPI: 1548123920
Provider Name (Legal Business Name): VIJAY JAYA PANCHOLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIJAY JAYA PANCHOLY DO

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SANDPIPER
IRVINE CA
92604-3647
US

IV. Provider business mailing address

8 SANDPIPER STREET
IRVINE CA
92604
US

V. Phone/Fax

Practice location:
  • Phone: 408-621-1512
  • Fax:
Mailing address:
  • Phone: 408-621-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: