Individual
PRAVIR R VATSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1023 NIPOMO ST # 110, SAN LUIS OBISPO, CA 93401-3882
(805) 439-2998
(805) 439-2997
Mailing address
1023 NIPOMO ST # 110, SAN LUIS OBISPO, CA 93401-3882
(805) 439-2998
(805) 439-2997
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A95811
CA
208M00000X
Hospitalist Physician
Primary
A95811
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A958110
BLUE SHIELD OF CA
CA
05
—
00A958110
—
CA
Enumeration date
09/15/2006
Last updated
08/17/2015
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