=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750829552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRISHA PEDIATRICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2017
-----------------------------------------------------
Last Update Date | 02/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E CALAVERAS BLVD SUITE 130
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-7703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-649-6451
-----------------------------------------------------
Fax | 408-649-6152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 E CALAVERAS BLVD SUITE 130
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-7703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-649-6451
-----------------------------------------------------
Fax | 408-649-6152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JIGNA S NEGANDHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 408-649-6451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A120079
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------