Provider Demographics
NPI:1821500729
Name:UPADHYAY, VIPRA NILKANTH
Entity Type:Individual
Prefix:
First Name:VIPRA
Middle Name:NILKANTH
Last Name:UPADHYAY
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 1:312 W CERRITOS AVE BLDG 7
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6550
Mailing Address - Country:US
Mailing Address - Phone:714-947-1213
Mailing Address - Fax:877-707-0708
Practice Address - Street 1:312 W CERRITOS AVE BLDG 7
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6550
Practice Address - Country:US
Practice Address - Phone:714-947-1213
Practice Address - Fax:877-707-0708
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist