Basic Information
Provider Information
NPI: 1003001645
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRIVEDI
FirstName: VINOD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1300 ETHAN WAY
Address2: SUITE 600
City: SACRAMENTO
State: CA
PostalCode: 95825
CountryCode: US
TelephoneNumber: 9166793590
FaxNumber: 9164823647
Practice Location
Address1: 1485 RIVER PARK DR
Address2: SUITE 200
City: SACRAMENTO
State: CA
PostalCode: 958154530
CountryCode: US
TelephoneNumber: 9163251040
FaxNumber: 9166694100
Other Information
ProviderEnumerationDate: 09/06/2007
LastUpdateDate: 09/11/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XGJ218ZCAY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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