Provider Demographics
NPI:1477830073
Name:PURNIMA THAKRAN MD INC
Entity type:Organization
Organization Name:PURNIMA THAKRAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PURNIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:760-242-0111
Mailing Address - Street 1:18387 US HIGHWAY 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 US HIGHWAY 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524650Medicare PIN