Provider Demographics
NPI:1285653543
Name:SINGH, PRITAM (MD)
Entity type:Individual
Prefix:
First Name:PRITAM
Middle Name:
Last Name:SINGH
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 1:735 E OHIO AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3437
Mailing Address - Country:US
Mailing Address - Phone:760-743-1033
Mailing Address - Fax:760-480-1015
Practice Address - Street 1:735 E OHIO AVE STE 204
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3437
Practice Address - Country:US
Practice Address - Phone:760-743-1033
Practice Address - Fax:760-480-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321340Medicaid
CAA23707Medicare UPIN
CA00A321340Medicaid