Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A63417 | CA |
N | 111NI0900X | Internist | A63417 | CA |
Y | 207RH0000X | Hematologist | A63417 | CA |
N | 207RH0003X | Hematology & Oncology | A63417 | CA |
NPI | 1164433645 |
---|---|
Provider Name | Mr. Vinod Pullarkat |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A634170 | (05) | CA |
1902846306 | GROUP NPI (01) | CA |
GR0100430 | GROUP MEDICAL (01) | CA |
H61055 | (02) | |
W18762 | GROUP MEDICARE (01) | CA |