Healthcare Provider Details

I. General information

NPI: 1457654394
Provider Name (Legal Business Name): PRAVDIN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 PRICE AVE
REDWOOD CITY CA
94063-1433
US

IV. Provider business mailing address

570 PRICE AVE
REDWOOD CITY CA
94063-1433
US

V. Phone/Fax

Practice location:
  • Phone: 650-701-1882
  • Fax: 650-701-1886
Mailing address:
  • Phone: 650-327-1258
  • Fax: 855-200-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY PRAVDIN
Title or Position: PRESIDENT
Credential: MD
Phone: 650-701-1882