Healthcare Provider Details

I. General information

NPI: 1174442727
Provider Name (Legal Business Name): RAMANVIR K SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

1207 BRISTLECONE DR
MADERA CA
93638-5830
US

V. Phone/Fax

Practice location:
  • Phone: 559-951-2747
  • Fax:
Mailing address:
  • Phone: 559-951-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95034333
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95222280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: