Healthcare Provider Details

I. General information

NPI: 1013528975
Provider Name (Legal Business Name): MR. PRATIK K AMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32225 TEMECULA PKWY
TEMECULA CA
92592-6811
US

IV. Provider business mailing address

39661 SAGEWOOD RDG
TEMECULA CA
92591-0361
US

V. Phone/Fax

Practice location:
  • Phone: 951-506-7631
  • Fax:
Mailing address:
  • Phone: 319-855-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90970
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23924
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: