=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306067012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJUL PARIKH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 W MARCH LN STE A
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95207-5726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-937-9010
-----------------------------------------------------
Fax | 209-937-9018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 W MARCH LN STE A
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95207-5726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-937-9010
-----------------------------------------------------
Fax | 209-937-9018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080H0002X
-----------------------------------------------------
Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
-----------------------------------------------------
License Number | A37746
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------