Healthcare Provider Details

I. General information

NPI: 1144517731
Provider Name (Legal Business Name): PURVI VAKIL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 GROSSMONT CENTER DR STE 200
LA MESA CA
91942-3074
US

IV. Provider business mailing address

5601 GROSSMONT CENTER DR STE 200
LA MESA CA
91942-3074
US

V. Phone/Fax

Practice location:
  • Phone: 951-756-3767
  • Fax:
Mailing address:
  • Phone: 951-756-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: