Healthcare Provider Details

I. General information

NPI: 1912734484
Provider Name (Legal Business Name): PALAK PANDIT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ACACIA AVE
SAN RAFAEL CA
94901-2230
US

IV. Provider business mailing address

6187 JOAQUIN MURIETA AVE APT I
NEWARK CA
94560-5417
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-4440
  • Fax:
Mailing address:
  • Phone: 669-254-6923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: