Provider Demographics
NPI:1548416050
Name:MAYANK J. VAKIL, MD
Entity Type:Organization
Organization Name:MAYANK J. VAKIL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-335-7800
Mailing Address - Street 1:216 S CITRUS ST # 322
Mailing Address - Street 2:#322
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2144
Mailing Address - Country:US
Mailing Address - Phone:626-335-7800
Mailing Address - Fax:626-335-7833
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:SUITE #302
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-335-7800
Practice Address - Fax:626-335-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46053302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization