Basic Information
Provider Information | |||||||||
NPI: | 1417078999 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PANDYA | ||||||||
FirstName: | AVNI | ||||||||
MiddleName: | BANSI | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11401 BLOOMFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | NORWALK | ||||||||
State: | CA | ||||||||
PostalCode: | 90650 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3143594691 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11401 BLOOMFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | NORWALK | ||||||||
State: | CA | ||||||||
PostalCode: | 90650 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7067213157 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/03/2007 | ||||||||
LastUpdateDate: | 01/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 00039201 | AL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 60628 | AZ | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | A117083 | CA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 0000609 | CO | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 054688 | CT | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | C1-0011698 | DE | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | ME125196 | FL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 036151557 | IL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 01075598A | IN | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 04-40105 | KS | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 49788 | KY | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 322039 | LA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | MD20710 | ME | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | D79972 | MD | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 059488 | GA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.