Provider Demographics
NPI:1205864451
Name:VERMANI, PAWAN K (MD)
Entity Type:Individual
Prefix:MR
First Name:PAWAN
Middle Name:K
Last Name:VERMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAWAN
Other - Middle Name:K
Other - Last Name:VERMANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:530 W BADILLO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3787
Mailing Address - Country:US
Mailing Address - Phone:626-966-1113
Mailing Address - Fax:626-967-2700
Practice Address - Street 1:530 W BADILLO ST
Practice Address - Street 2:SUITE B
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3787
Practice Address - Country:US
Practice Address - Phone:626-966-1113
Practice Address - Fax:626-967-2700
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A623310Medicaid
CAA62331Medicare ID - Type Unspecified
CAH12951Medicare UPIN