Provider Demographics
NPI:1316972425
Name:DHANDA, PAULA R
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:R
Last Name:DHANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5685 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-8945
Mailing Address - Country:US
Mailing Address - Phone:707-263-8733
Mailing Address - Fax:707-279-8731
Practice Address - Street 1:5685 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KELSEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95451
Practice Address - Country:US
Practice Address - Phone:707-263-8733
Practice Address - Fax:707-262-0313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62526207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061470Medicaid
CAGR0061470Medicaid
E04677Medicare UPIN