Provider Demographics
NPI:1033240338
Name:KHORAKIWALA, DURRIYAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DURRIYAH
Middle Name:
Last Name:KHORAKIWALA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-9737
Mailing Address - Country:US
Mailing Address - Phone:925-413-6964
Mailing Address - Fax:925-485-1252
Practice Address - Street 1:7567 AMADOR VALLEY BLVD
Practice Address - Street 2:#202
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2441
Practice Address - Country:US
Practice Address - Phone:925-485-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13482103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY134820Medicaid
CAPSY134820Medicaid