Provider Demographics
NPI:1083747653
Name:LALWANI, PREM GOPALDAS (OTR CHT CSE)
Entity Type:Individual
Prefix:MR
First Name:PREM
Middle Name:GOPALDAS
Last Name:LALWANI
Suffix:
Gender:M
Credentials:OTR CHT CSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6668
Mailing Address - Country:US
Mailing Address - Phone:408-887-3149
Mailing Address - Fax:408-956-1064
Practice Address - Street 1:2305 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6668
Practice Address - Country:US
Practice Address - Phone:408-887-3149
Practice Address - Fax:408-956-1064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 137171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider