MEDICARE: DYNAMIC HEALTH AND WELLNESS INC A PROFESSIONAL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G31686	CA
2	208600000X	Surgery Physician	G87823	CA
3	207R00000X	Internal Medicine Physician	A99906	CA

General Provider Information

NPI Number	:	1942645502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC HEALTH AND WELLNESS INC A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	441 COLUSA AVE
Second Line	:	SUITE B
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4143
Country	:	US
Telephone Number	:	530-329-8462
Fax Number	:	530-329-8545

Provider Business Practice Location Address
First Line	:	441 COLUSA AVE
Second Line	:	SUITE B
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4143
Country	:	US
Telephone Number	:	530-329-8462
Fax Number	:	530-329-8545

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TANYA BROWN RANDHAWA
Credential	:	M.D.
Telephone Number	:	530-680-8306

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	09/25/2013

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