MEDICARE: MRS. PRONOTI NIGAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	C43125	CA

General Provider Information

NPI Number	:	1053390310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRONOTI NIGAM MD

Provider Business Mailing Address
First Line	:	4205 SAN FELIPE RD
Second Line	:	#110
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1503
Country	:	US
Telephone Number	:	408-238-8303
Fax Number	:	408-238-8375

Provider Business Practice Location Address
First Line	:	4205 SAN FELIPE RD
Second Line	:	SUITE 110
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1503
Country	:	US
Telephone Number	:	408-238-8303
Fax Number	:	408-238-8375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	03/13/2013

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