Provider Demographics
NPI:1366518342
Name:MISTRY, PANKAJ NANUBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:NANUBHAI
Last Name:MISTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4219
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-0219
Mailing Address - Country:US
Mailing Address - Phone:626-919-5437
Mailing Address - Fax:626-919-5439
Practice Address - Street 1:933 S SUNSET AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3410
Practice Address - Country:US
Practice Address - Phone:626-919-5437
Practice Address - Fax:626-919-5439
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44860208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty