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General NPI Number Information
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NPI Number | 1972702231
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Entity Type | Organization
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Legal Business Name | PERVAIZ CHANNAH AND ASSOCIATES
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 25109 JEFFERSON AVE STE 105
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City | MURRIETA
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State | CA
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Zip | 92562-8117
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Country | US
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Telephone | 951-698-5765
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Fax | 951-698-0254
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Provider Business Mailing Address
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Address Line | 25109 JEFFERSON AVENUE STE 105
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City | MURRIETA
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State | CA
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Zip | 92562-5857
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Country | US
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Telephone | 951-698-5765
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Fax | 951-698-0254
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Authorized Official
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Title or Position | OWNER
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Name | DR. PERVAIZ CHANNAH
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Credential | M.D.
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Telephone | 951-698-5765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A053353
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License Number State | CA
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