MEDICARE: PAVANI VASHISHTHA

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	225B00000X	Pulmonary Function Technologist

General Provider Information

NPI Number	:	1144782897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAVANI VASHISHTHA

Provider Business Mailing Address
First Line	:	1670 E 120TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3026
Country	:	US
Telephone Number	:	424-338-1484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 SALEROSO DR
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-4163
Country	:	US
Telephone Number	:	626-806-5507
Fax Number	:

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/02/2019

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