Basic Information
Provider Information
NPI: 1245478171
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VAKIL
FirstName: CHAULA
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 246 SOBRANTE WAY
Address2:  
City: SUNNYVALE
State: CA
PostalCode: 940864807
CountryCode: US
TelephoneNumber: 4087333670
FaxNumber: 4082457968
Practice Location
Address1: 490 W EL CAMINO REAL
Address2:  
City: MOUNTAIN VIEW
State: CA
PostalCode: 940402610
CountryCode: US
TelephoneNumber: 6509617370
FaxNumber: 6509617370
Other Information
ProviderEnumerationDate: 01/30/2009
LastUpdateDate: 01/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 29202CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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