MEDICARE: MUKTI PALEJWALA P.A.

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	363A00000X	Physician Assistant	PA 17666	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA 17666	OTHER	CA	P.A. LICENCE

General Provider Information

NPI Number	:	1679688402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKTI PALEJWALA P.A.

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	SUITE 315
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	213-385-0630
Fax Number	:	213-385-0675

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	SUITE 315
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	213-385-0630
Fax Number	:	213-385-0675

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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