Healthcare Provider Details

I. General information

NPI: 1972876613
Provider Name (Legal Business Name): PAVNEET MAVI DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15775 WASHINGTON AVE
SAN LORENZO CA
94580-1430
US

IV. Provider business mailing address

15775 WASHINGTON AVE
SAN LORENZO CA
94580-1430
US

V. Phone/Fax

Practice location:
  • Phone: 510-278-8440
  • Fax: 510-276-9224
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number18953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: