Provider Demographics
NPI:1942239892
Name:KAPOOR, VISHWA MOHINI (MD)
Entity Type:Individual
Prefix:
First Name:VISHWA
Middle Name:MOHINI
Last Name:KAPOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2280
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2280
Mailing Address - Country:US
Mailing Address - Phone:760-604-2714
Mailing Address - Fax:760-344-7106
Practice Address - Street 1:1745 S IMPERIAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4243
Practice Address - Country:US
Practice Address - Phone:760-604-2714
Practice Address - Fax:760-344-7106
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A418700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497026439Medicaid