Healthcare Provider Details

I. General information

NPI: 1285077669
Provider Name (Legal Business Name): NAGVIR K SANDHU D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAGVIR K SIDHU DPM

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

17097 LONGVIEW CT
LATHROP CA
95330-8262
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6022
  • Fax:
Mailing address:
  • Phone: 209-505-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2200
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: