# PRABHJIT S. PUREWAL, MD, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831206432
- **Authorized official:** PRABHJIT PUREWAL (CEO)
- **Authorized official phone:** (209) 477-2000

## Contact information

- **Practice address:** 200 COTTAGE AVE, STE 201, MANTECA, CA 95336-4935
- **Practice address phone:** (209) 477-2000
- **Practice address fax:** (209) 477-0248
- **Mailing address:** PO BOX 7935, STOCKTON, CA 95267-0935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A48423 | CA | Yes |

## Other

- **Enumeration date:** 08/23/2006
- **Last updated:** 06/22/2009