Provider Demographics
NPI:1962471961
Name:PRAVIN, PARESH H (MD)
Entity Type:Individual
Prefix:DR
First Name:PARESH
Middle Name:H
Last Name:PRAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 B GALE WILSON BLVD STE 1559
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3587
Mailing Address - Country:US
Mailing Address - Phone:707-646-5080
Mailing Address - Fax:707-646-4907
Practice Address - Street 1:1200 B GALE WILSON BLVD STE 1559
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3587
Practice Address - Country:US
Practice Address - Phone:707-646-5080
Practice Address - Fax:707-646-4907
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A760560Medicaid
H59779Medicare UPIN
00A760562Medicare PIN