Healthcare Provider Details

I. General information

NPI: 1720078314
Provider Name (Legal Business Name): SUKHDEV K UPPAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAGNOLIA AVE SUITE 107
CORONA CA
92879-3123
US

IV. Provider business mailing address

800 MAGNOLIA AVE SUITE 107
CORONA CA
92879-3123
US

V. Phone/Fax

Practice location:
  • Phone: 951-372-0955
  • Fax: 951-372-0918
Mailing address:
  • Phone: 951-372-0955
  • Fax: 951-372-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA54106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: