Provider Demographics
NPI:1790861490
Name:VIMALI PAUL, MD
Entity Type:Organization
Organization Name:VIMALI PAUL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIMALI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-894-6600
Mailing Address - Street 1:85 DECLARATION DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4902
Mailing Address - Country:US
Mailing Address - Phone:530-894-6600
Mailing Address - Fax:530-894-1321
Practice Address - Street 1:85 DECLARATION DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4902
Practice Address - Country:US
Practice Address - Phone:530-894-6600
Practice Address - Fax:530-894-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110174445OtherMEDICARE RAILROAD #
DG8519OtherMEDICARE RAILROAD GROUP #
CA00A535200Medicaid
CAG08480Medicare UPIN
CAZZZ26397ZMedicare PIN