Provider Demographics
NPI:1629644596
Name:PRENUVO OF CALIFORNIA P.C.
Entity Type:Organization
Organization Name:PRENUVO OF CALIFORNIA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJPAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-218-9134
Mailing Address - Street 1:2727 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3910
Mailing Address - Country:US
Mailing Address - Phone:415-218-9134
Mailing Address - Fax:
Practice Address - Street 1:2727 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3910
Practice Address - Country:US
Practice Address - Phone:415-218-9134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology