Healthcare Provider Details

I. General information

NPI: 1417688078
Provider Name (Legal Business Name): SANJIV MIDHA MD A MEDICAL CORPORATION A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EAST GRIDLEY RD
GRIDLEY CA
95948
US

IV. Provider business mailing address

1215 PLUMAS ST STE 500
YUBA CITY CA
95991-3453
US

V. Phone/Fax

Practice location:
  • Phone: 530-674-2100
  • Fax:
Mailing address:
  • Phone: 530-898-1201
  • Fax: 530-898-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANJIV MIDHA
Title or Position: PRESIDENT
Credential: MD
Phone: 530-674-2100