Provider Demographics
NPI:1386034130
Name:VASA, HIRAL GAURAV (DPT)
Entity Type:Individual
Prefix:
First Name:HIRAL
Middle Name:GAURAV
Last Name:VASA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HIRAL
Other - Middle Name:
Other - Last Name:TURAKHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5061 LA LUNA DR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2002
Mailing Address - Country:US
Mailing Address - Phone:562-412-5232
Mailing Address - Fax:
Practice Address - Street 1:3851 KATELLA AVE STE 365
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3377
Practice Address - Country:US
Practice Address - Phone:562-334-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist