Provider Demographics
NPI:1841338480
Name:VASANT, KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:
Last Name:VASANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40285 WINCHESTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5547
Mailing Address - Country:US
Mailing Address - Phone:951-296-2055
Mailing Address - Fax:951-296-2053
Practice Address - Street 1:40285 WINCHESTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5547
Practice Address - Country:US
Practice Address - Phone:951-296-2055
Practice Address - Fax:951-296-2053
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35059261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD19861Medicare UPIN