Provider Demographics
NPI:1063032837
Name:UTTWANI, DEEPA PANKAJ
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:PANKAJ
Last Name:UTTWANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 MARINERO PL
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-2567
Mailing Address - Country:US
Mailing Address - Phone:805-625-3531
Mailing Address - Fax:
Practice Address - Street 1:1522 MARINERO PL
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-2567
Practice Address - Country:US
Practice Address - Phone:805-625-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist