Healthcare Provider Details

I. General information

NPI: 1629265046
Provider Name (Legal Business Name): MAYUR TRIVEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2007
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD SUITE #103
SIMI VALLEY CA
93065-6508
US

IV. Provider business mailing address

2060D AVENIDA DE LOS ARBOLES SUITE #574
THOUSAND OAKS CA
91362-1376
US

V. Phone/Fax

Practice location:
  • Phone: 805-492-4463
  • Fax: 866-496-4990
Mailing address:
  • Phone: 805-492-4463
  • Fax: 866-496-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA91177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: