Provider Demographics
NPI:1225181241
Name:VAIDYA-NATHAN, HEMA L (MD)
Entity Type:Individual
Prefix:DR
First Name:HEMA
Middle Name:L
Last Name:VAIDYA-NATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W JANSS RD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1848
Mailing Address - Country:US
Mailing Address - Phone:805-496-0135
Mailing Address - Fax:805-496-4222
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 335
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-496-0135
Practice Address - Fax:805-496-4222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87837Medicare UPIN