Provider Demographics
NPI:1861449985
Name:VAKIL, MAYANK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYANK
Middle Name:J
Last Name:VAKIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:216 S CITRUS ST
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA46053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ788YOtherMEDICARE PTAN
CAAZ788YOtherMEDICARE PTAN