Provider Demographics
NPI:1528099264
Name:PROMILA DHANUKA, M.D., INC.
Entity type:Organization
Organization Name:PROMILA DHANUKA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PROMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-247-1425
Mailing Address - Street 1:PO BOX 994190
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4190
Mailing Address - Country:US
Mailing Address - Phone:530-247-1425
Mailing Address - Fax:530-247-1533
Practice Address - Street 1:2145 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2531
Practice Address - Country:US
Practice Address - Phone:530-247-1425
Practice Address - Fax:530-247-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95171207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225094469Medicaid
CAP00653547OtherRAILROAD MEDICARE
CAA95171OtherMEDICAL LICENSE
CA1225094469Medicaid
ZZZ02594ZMedicare PIN