Provider Demographics
NPI:1366550253
Name:PAWAR, SANYUKTA SANJAY (MD)
Entity type:Individual
Prefix:
First Name:SANYUKTA
Middle Name:SANJAY
Last Name:PAWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W RANCH VIEW DR
Mailing Address - Street 2:SUITE 2005
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5396
Mailing Address - Country:US
Mailing Address - Phone:916-295-5700
Mailing Address - Fax:916-295-5769
Practice Address - Street 1:550 W RANCH VIEW DR
Practice Address - Street 2:SUITE 2005
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5396
Practice Address - Country:US
Practice Address - Phone:916-295-5700
Practice Address - Fax:916-295-5769
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
245506204Medicare ID - Type Unspecified
G31477Medicare UPIN