Healthcare Provider Details

I. General information

NPI: 1053891754
Provider Name (Legal Business Name): TEJINDER S. RANDHAWA M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N ABBY ST
FRESNO CA
93701-1906
US

IV. Provider business mailing address

PO BOX 25578
FRESNO CA
93729-5578
US

V. Phone/Fax

Practice location:
  • Phone: 559-580-8088
  • Fax: 559-253-1302
Mailing address:
  • Phone: 559-580-8088
  • Fax: 559-253-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TEJINDER SINGH RANDHAWA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-580-8088