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General NPI Number Information
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NPI Number | 1154184018
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Entity Type | Organization
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Legal Business Name | PURE PULSE HEALTH PHYSICIAN ASSISTANT, INC
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 802 MAGNOLIA AVE STE 102
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City | CORONA
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State | CA
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Zip | 92879-3124
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Country | US
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Telephone | 714-455-9831
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Fax |
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Provider Business Mailing Address
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Address Line | 802 MAGNOLIA AVE STE 102
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City | CORONA
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State | CA
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Zip | 92879-3124
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Country | US
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Telephone | 714-455-9831
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. DIPALI P RADIA
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Credential | PA-C
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Telephone | 714-553-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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