Basic Information
| Provider Information | |||||||||
| NPI: | 1689939860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VORA | ||||||||
| FirstName: | MAULIN | ||||||||
| MiddleName: | UPENDRA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.B.B.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4623 THOMAS LAKE HARRIS DR UNIT 311 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954030195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025172446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1165 MONTGOMERY DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025594081 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2012 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 29977 | NE | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | A139306 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | A139306 | 01 | CA | STATE MEDICAL LICENSE | OTHER |