Healthcare Provider Details

I. General information

NPI: 1811148224
Provider Name (Legal Business Name): PARU R CHAUDHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LA CASA VIA STE 101
WALNUT CREEK CA
94598-3092
US

IV. Provider business mailing address

120 LA CASA VIA STE 101
WALNUT CREEK CA
94598-3092
US

V. Phone/Fax

Practice location:
  • Phone: 925-722-6500
  • Fax: 925-386-7680
Mailing address:
  • Phone: 925-722-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSTUDENT
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number267800
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA109338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: