Provider Demographics
NPI:1336415207
Name:MATHUKIA, CHIRAG M
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:M
Last Name:MATHUKIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 ISLAND PARK CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9492
Mailing Address - Country:US
Mailing Address - Phone:661-378-6364
Mailing Address - Fax:
Practice Address - Street 1:5055 CALIFORNIA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0701
Practice Address - Country:US
Practice Address - Phone:661-334-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133272208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist