Provider Demographics
NPI:1073736138
Name:HARESH M.RUPAREL,MD.A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HARESH M.RUPAREL,MD.A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUPAREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-295-2108
Mailing Address - Street 1:1072 S DE ANZA BLVD
Mailing Address - Street 2:# 497
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3500
Mailing Address - Country:US
Mailing Address - Phone:408-295-2108
Mailing Address - Fax:510-445-0724
Practice Address - Street 1:1072 S DE ANZA BLVD
Practice Address - Street 2:# 497
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3500
Practice Address - Country:US
Practice Address - Phone:408-295-2108
Practice Address - Fax:510-445-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42592Medicare UPIN
CA00C424790Medicare PIN