Provider Demographics
NPI:1104410430
Name:RANDHAWA, MANJINDER S (NP)
Entity type:Individual
Prefix:
First Name:MANJINDER
Middle Name:S
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 SANBORN RD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-6045
Mailing Address - Country:US
Mailing Address - Phone:530-300-7815
Mailing Address - Fax:
Practice Address - Street 1:1260 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2400
Practice Address - Country:US
Practice Address - Phone:530-751-4295
Practice Address - Fax:530-749-4906
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF09200045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner