Provider Demographics
NPI:1013950658
Name:VORA, DIPAK G (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPAK
Middle Name:G
Last Name:VORA
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 1:705 E VIRGINIA WAY
Mailing Address - Street 2:SUITE - I
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3978
Mailing Address - Country:US
Mailing Address - Phone:760-256-1422
Mailing Address - Fax:760-256-6418
Practice Address - Street 1:705 E VIRGINIA WAY
Practice Address - Street 2:SUITE - I
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3978
Practice Address - Country:US
Practice Address - Phone:760-256-1422
Practice Address - Fax:760-256-6418
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A455580Medicaid
B39679Medicare UPIN
00A455580Medicare ID - Type Unspecified