Provider Demographics
NPI:1407387566
Name:VAIDYA, POORVA
Entity Type:Individual
Prefix:
First Name:POORVA
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 HEALTH SCIENCES DR # MC0829
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0829
Mailing Address - Country:US
Mailing Address - Phone:858-657-5281
Mailing Address - Fax:858-657-5348
Practice Address - Street 1:3855 HEALTH SCIENCES DRIVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0829
Practice Address - Country:US
Practice Address - Phone:858-657-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program