Provider Demographics
NPI:1093264400
Name:RAVAL, CHANDNI VINAY (PA)
Entity Type:Individual
Prefix:
First Name:CHANDNI
Middle Name:VINAY
Last Name:RAVAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHANDNI
Other - Middle Name:VINAY
Other - Last Name:KAPADIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2196 FENTON PKWY
Mailing Address - Street 2:APARTMENT 217
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4770
Mailing Address - Country:US
Mailing Address - Phone:623-570-0595
Mailing Address - Fax:
Practice Address - Street 1:5333 MISSION CENTER RD
Practice Address - Street 2:SUITE #100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1302
Practice Address - Country:US
Practice Address - Phone:619-295-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant