Provider Demographics
NPI:1700881448
Name:PAUL, VIMALI (MD)
Entity type:Individual
Prefix:DR
First Name:VIMALI
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 DECLARATION DR
Mailing Address - Street 2:STE 110
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4902
Mailing Address - Country:US
Mailing Address - Phone:530-894-6600
Mailing Address - Fax:530-894-1321
Practice Address - Street 1:85 DECLARATION DR
Practice Address - Street 2:STE 110
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4902
Practice Address - Country:US
Practice Address - Phone:530-894-6600
Practice Address - Fax:530-894-1321
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110174445OtherMEDICARE RAILROAD #
CA00A535200Medicaid
CA00A535201Medicare PIN
CAG08480Medicare UPIN