Provider Demographics
NPI:1447518816
Name:VIMALI PAUL MD INC
Entity type:Organization
Organization Name:VIMALI PAUL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-894-6600
Mailing Address - Street 1:85 DECLARATION DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4964
Mailing Address - Country:US
Mailing Address - Phone:530-894-6600
Mailing Address - Fax:530-894-1321
Practice Address - Street 1:85 DECLARATION DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:530-894-6600
Practice Address - Fax:530-894-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53520261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A535200Medicare PIN