Provider Demographics
NPI:1205033594
Name:VAIDYA, PARISH SUBHASH (MD)
Entity type:Individual
Prefix:DR
First Name:PARISH
Middle Name:SUBHASH
Last Name:VAIDYA
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 1:92 CORPORATE PARK
Mailing Address - Street 2:SUITE C-330
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5146
Mailing Address - Country:US
Mailing Address - Phone:949-335-7411
Mailing Address - Fax:
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3189
Practice Address - Country:US
Practice Address - Phone:949-335-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6924208100000X
CAA105629208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187646801Medicaid
TX8J7338Medicare PIN
TX187646801Medicaid
TX8K2929Medicare PIN