Basic Information
Provider Information | |||||||||
NPI: | 1467590240 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DANFORTH | ||||||||
FirstName: | PALLAVI | ||||||||
MiddleName: | ABHYANKAR | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DANFORTH | ||||||||
OtherFirstName: | PALLAVI | ||||||||
OtherMiddleName: | ABHYANKAR | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 255228 | ||||||||
Address2: |   | ||||||||
City: | SACRAMENTO | ||||||||
State: | CA | ||||||||
PostalCode: | 958655228 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8666810736 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 969 PLUMAS ST STE 116 | ||||||||
Address2: |   | ||||||||
City: | YUBA CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 959914011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5307493585 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/02/2007 | ||||||||
LastUpdateDate: | 11/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/22/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 20A8287 | CA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 174400000X | 20A8287 | CA | N |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | OOAX82870 | 05 | CA |   | MEDICAID |