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General NPI Number Information
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NPI Number | 1902345747
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Entity Type | Organization
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Legal Business Name | PUJA THAKKAR, D.O., MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 400 EL CERRO BLVD SUITE 107
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City | DANVILLE
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State | CA
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Zip | 94526-1731
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Country | US
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Telephone | 925-820-4472
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Fax | 925-820-2650
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Provider Business Mailing Address
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Address Line | 400 EL CERRO BLVD SUITE 107
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City | DANVILLE
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State | CA
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Zip | 94526-1731
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Country | US
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Telephone | 925-820-4472
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Fax | 925-820-2650
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Authorized Official
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Title or Position | PRESIDENT
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Name | PUJA ANIL THAKKAR
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Credential | D.O.
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Telephone | 925-820-4472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 20A12339
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License Number State | CA
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