Healthcare Provider Details

I. General information

NPI: 1548387673
Provider Name (Legal Business Name): RAJINDER SINGH RANDHAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAJINDER SINGH RANDHAWA M.D.

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 TENNIS CT
ANTELOPE CA
95843-4667
US

IV. Provider business mailing address

7720 TENNIS CT
ANTELOPE CA
95843-4667
US

V. Phone/Fax

Practice location:
  • Phone: 916-721-8886
  • Fax: 530-822-7108
Mailing address:
  • Phone: 916-721-8886
  • Fax: 530-822-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC50081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: