Provider Demographics
NPI:1336280031
Name:MEHRA, PURVI KOTHARI (MD)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:KOTHARI
Last Name:MEHRA
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 1:770 WASHINGTON ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2209
Mailing Address - Country:US
Mailing Address - Phone:858-278-3647
Mailing Address - Fax:
Practice Address - Street 1:770 WASHINGTON ST
Practice Address - Street 2:SUITE #200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2209
Practice Address - Country:US
Practice Address - Phone:858-278-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77567207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology