Healthcare Provider Details

I. General information

NPI: 1902069438
Provider Name (Legal Business Name): TEJAL THAKKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S DEPARTMENT OF RHEUMATOLOGY
ORANGE CA
92868-3201
US

IV. Provider business mailing address

PO BOX 14481
IRVINE CA
92623-4481
US

V. Phone/Fax

Practice location:
  • Phone: 714-506-8373
  • Fax:
Mailing address:
  • Phone: 714-506-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA95652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: