Organization
PRABHJIT S. PUREWAL, MD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRABHJIT PUREWAL (CEO)
(209) 477-2000
Entity
Organization
Contact information
Practice address
200 COTTAGE AVE, STE 201, MANTECA, CA 95336-4935
(209) 477-2000
(209) 477-0248
Mailing address
PO BOX 7935, STOCKTON, CA 95267-0935
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A48423
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A48423
—
CA
01
—
5622368
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/23/2006
Last updated
06/22/2009
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