Provider Demographics
NPI:1588764526
Name:WADHWANI, SUNEEL H (MD)
Entity type:Individual
Prefix:
First Name:SUNEEL
Middle Name:H
Last Name:WADHWANI
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 1:590 W PUTNAM AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3257
Mailing Address - Country:US
Mailing Address - Phone:559-784-5755
Mailing Address - Fax:559-781-4666
Practice Address - Street 1:590 W PUTNAM AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3257
Practice Address - Country:US
Practice Address - Phone:559-784-5755
Practice Address - Fax:559-781-4666
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A417610Medicaid
00A417610Medicare ID - Type Unspecified
CA00A417610Medicaid