Healthcare Provider Details

I. General information

NPI: 1891994109
Provider Name (Legal Business Name): GOOLRUKH ADI VAKIL MA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 UNIVERSITY AVE
PALO ALTO CA
94301-1812
US

IV. Provider business mailing address

472 UNIVERSITY AVE
PALO ALTO CA
94301
US

V. Phone/Fax

Practice location:
  • Phone: 415-845-8519
  • Fax: 650-473-1744
Mailing address:
  • Phone: 415-845-8519
  • Fax: 650-473-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 47460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: