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General NPI Number Information
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NPI Number | 1689987521
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Entity Type | Organization
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Legal Business Name | PRAVIN J KANSAGRA MD INC
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1020 S ANAHEIM BLVD SUITE 215
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City | ANAHEIM
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State | CA
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Zip | 92805-5851
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Country | US
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Telephone | 714-335-8570
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Fax | 714-280-0128
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Provider Business Mailing Address
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Address Line | 1092 S TAYLOR CT
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City | ANAHEIM
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State | CA
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Zip | 92808-2425
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Country | US
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Telephone | 714-335-8570
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Fax | 714-280-0128
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Authorized Official
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Title or Position | OWNER
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Name | PRAVIN J KANSAGRA, MD
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Credential | MD
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Telephone | 714-335-8570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A44685
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License Number State | CA
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