Provider Demographics
NPI:1336792662
Name:CONJEEVARAM SELVAKUMAR, PREETHI (MD)
Entity type:Individual
Prefix:DR
First Name:PREETHI
Middle Name:
Last Name:CONJEEVARAM SELVAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PREETHI
Other - Middle Name:
Other - Last Name:C S
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1910 CUSTOMER CARE WAY
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5167
Mailing Address - Country:US
Mailing Address - Phone:209-722-4842
Mailing Address - Fax:
Practice Address - Street 1:1120 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2021
Practice Address - Country:US
Practice Address - Phone:209-722-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA190095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics