Healthcare Provider Details

I. General information

NPI: 1285751222
Provider Name (Legal Business Name): SANJIV K MIDHA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 MARKET ST SUITE B
COLUSA CA
95932-2422
US

IV. Provider business mailing address

2017 EAGER RD
LIVE OAK CA
95953-9741
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-2300
  • Fax:
Mailing address:
  • Phone: 530-674-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70328
License Number StateCA

VIII. Authorized Official

Name: DR. SANJIV MIDHA
Title or Position: OWNER
Credential: M.D.
Phone: 530-674-2100