Provider Demographics
NPI:1225024219
Name:PANJABI, RAVI S (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:S
Last Name:PANJABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 CASTRO VALLEY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5565
Mailing Address - Country:US
Mailing Address - Phone:510-582-8555
Mailing Address - Fax:510-581-8686
Practice Address - Street 1:3160 CASTRO VALLEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5565
Practice Address - Country:US
Practice Address - Phone:510-582-8555
Practice Address - Fax:510-581-8686
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2024-08-20
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-11-09
Provider Licenses
StateLicense IDTaxonomies
CAA55600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F55075Medicare UPIN
CAZZZ19542ZMedicare ID - Type Unspecified