Healthcare Provider Details

I. General information

NPI: 1326077496
Provider Name (Legal Business Name): SUJAL M. NANAVATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # M-391
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

1635 DIVISADERO ST SUITE 625, BOX 1821
SAN FRANCISCO CA
94115-3045
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1468
  • Fax: 415-353-8596
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA81399
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA81399
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA81399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: