Healthcare Provider Details

I. General information

NPI: 1164789350
Provider Name (Legal Business Name): RAJINDER SINGH RANDHAWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
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: 916-715-2480
  • Fax: 916-721-9137
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberC50081
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberC50081
License Number StateCA

VIII. Authorized Official

Name: DR. RAJINDER SINGH RANDHAWA
Title or Position: STAFF PHYSICIAN
Credential: M.D.,
Phone: 916-715-2480