Healthcare Provider Details

I. General information

NPI: 1487834131
Provider Name (Legal Business Name): RITA RAKESH WADHWANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA KEWALRAMANI M.D

II. Dates (important events)

Enumeration Date: 11/10/2007
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43850 N MORAY ST
FREMONT CA
94539-5940
US

IV. Provider business mailing address

43850 N MORAY ST
FREMONT CA
94539-5940
US

V. Phone/Fax

Practice location:
  • Phone: 510-371-0333
  • Fax:
Mailing address:
  • Phone: 510-371-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: