Provider Demographics
NPI:1508371873
Name:GOVIND, PRATIK SHIRISH (MSHS, PA-C)
Entity type:Individual
Prefix:MR
First Name:PRATIK
Middle Name:SHIRISH
Last Name:GOVIND
Suffix:
Gender:M
Credentials:MSHS, PA-C
Other - Prefix:MR
Other - First Name:PRATIK
Other - Middle Name:SHIRISH
Other - Last Name:GOVINDJIE-GOVIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:925-482-8239
Practice Address - Street 1:795 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2302
Practice Address - Country:US
Practice Address - Phone:650-853-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005879363A00000X
MDC0006547363A00000X
CA54756363A00000X
DCPA031389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant