Healthcare Provider Details

I. General information

NPI: 1639689474
Provider Name (Legal Business Name): PRIYANKA THAPA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 W LAS POSITAS BLVD STE 100
PLEASANTON CA
94588-8537
US

IV. Provider business mailing address

2333 MOWRY AVE
FREMONT CA
94538-1625
US

V. Phone/Fax

Practice location:
  • Phone: 925-462-1755
  • Fax:
Mailing address:
  • Phone: 510-744-9062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: