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General NPI Number Information
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NPI Number | 1992799530
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Entity Type | Individual
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Provider Name | PRAVIN M PANCHAL MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 10/18/2020
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Provider Practice Location Address
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Address Line | 9670 MAGNOLIA AVE STE 201
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City | RIVERSIDE
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State | CA
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Zip | 92503-3684
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Country | US
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Telephone | 951-333-3662
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Fax | 951-352-3161
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Provider Business Mailing Address
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Address Line | 9670 MAGNOLIA AVE STE 201
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City | RIVERSIDE
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State | CA
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Zip | 92503-3684
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Country | US
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Telephone | 951-352-7400
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Fax | 951-352-3161
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A066826
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License Number State | CA
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