Provider Demographics
NPI:1992391197
Name:KUVADIA, MUKESH JAYANTILAL (PA)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:JAYANTILAL
Last Name:KUVADIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W BONITA AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4574
Mailing Address - Country:US
Mailing Address - Phone:914-338-3149
Mailing Address - Fax:
Practice Address - Street 1:630 W BONITA AVE APT 3C
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4574
Practice Address - Country:US
Practice Address - Phone:914-338-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA61390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty