Provider Demographics
NPI:1184706616
Name:THAKRAN, PURNIMA (MD, PHD)
Entity type:Individual
Prefix:
First Name:PURNIMA
Middle Name:
Last Name:THAKRAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18387 HWY 18
Mailing Address - Street 2:SUITES 1 & 2
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2214
Mailing Address - Country:US
Mailing Address - Phone:760-242-0111
Mailing Address - Fax:760-242-0877
Practice Address - Street 1:18387 HWY 18
Practice Address - Street 2:SUITES 1 & 2
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2214
Practice Address - Country:US
Practice Address - Phone:760-242-0111
Practice Address - Fax:760-242-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524650Medicaid
CA00A524651Medicaid
CAFV756Medicare PIN