Healthcare Provider Details

I. General information

NPI: 1649834284
Provider Name (Legal Business Name): PINALI VAIDYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 BLOSSOM HILL RD
SAN JOSE CA
95123-3301
US

IV. Provider business mailing address

202 CALVERT DR APT 110
CUPERTINO CA
95014-3707
US

V. Phone/Fax

Practice location:
  • Phone: 408-578-4900
  • Fax:
Mailing address:
  • Phone: 408-828-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: