Provider Demographics
NPI:1801304092
Name:ICHHAPORIA, RUPAL MATANI
Entity type:Individual
Prefix:
First Name:RUPAL
Middle Name:MATANI
Last Name:ICHHAPORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 BELSHAW DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5472
Mailing Address - Country:US
Mailing Address - Phone:408-435-5496
Mailing Address - Fax:
Practice Address - Street 1:512 BELSHAW DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5472
Practice Address - Country:US
Practice Address - Phone:408-435-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist