Basic Information
Provider Information
NPI: 1457432726
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAPOOR
FirstName: DEVENDRA
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7096
Address2:  
City: STOCKTON
State: CA
PostalCode: 952670096
CountryCode: US
TelephoneNumber: 2099567725
FaxNumber: 2099567733
Practice Location
Address1: 207 W. LEGION
Address2:  
City: BRAWLEY
State: CA
PostalCode: 922277780
CountryCode: US
TelephoneNumber: 7603513333
FaxNumber: 9517652855
Other Information
ProviderEnumerationDate: 10/17/2006
LastUpdateDate: 04/15/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA42875CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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