Healthcare Provider Details

I. General information

NPI: 1124753975
Provider Name (Legal Business Name): NIYATI VYARAWALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TUSTIN AVE STE 100
SANTA ANA CA
92705-3880
US

IV. Provider business mailing address

400 N TUSTIN AVE STE 100
SANTA ANA CA
92705-3880
US

V. Phone/Fax

Practice location:
  • Phone: 714-243-5450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95021614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: