Provider Demographics
NPI:1891994109
Name:VAKIL, GOOLRUKH ADI (MA, MS)
Entity Type:Individual
Prefix:MS
First Name:GOOLRUKH
Middle Name:ADI
Last Name:VAKIL
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:415-845-8519
Mailing Address - Fax:650-473-1744
Practice Address - Street 1:472 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1812
Practice Address - Country:US
Practice Address - Phone:415-845-8519
Practice Address - Fax:650-473-1744
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 47460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XMedicaid