Healthcare Provider Details

I. General information

NPI: 1750870150
Provider Name (Legal Business Name): VIKAS MAHESHWARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MONTGOMERY ST
SAN FRANCISCO CA
94104-4205
US

IV. Provider business mailing address

23741 VANOVEN ST
WEST HILLS CA
91307-3000
US

V. Phone/Fax

Practice location:
  • Phone: 857-205-8894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number9798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: