Healthcare Provider Details

I. General information

NPI: 1679319289
Provider Name (Legal Business Name): MUKUL AERI FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

18808 FAGAN AVE
ARTESIA CA
90701-5803
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax:
Mailing address:
  • Phone: 657-337-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95030825
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: