Healthcare Provider Details

I. General information

NPI: 1528601218
Provider Name (Legal Business Name): MY DIABETES TUTOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W GRANGEVILLE BLVD
HANFORD CA
93230-2861
US

IV. Provider business mailing address

PO BOX 1669
HANFORD CA
93232-1669
US

V. Phone/Fax

Practice location:
  • Phone: 844-623-0999
  • Fax: 844-306-5999
Mailing address:
  • Phone: 559-587-1100
  • Fax: 559-587-9044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PREM SAHASRANAM
Title or Position: PRESIDENT
Credential: MD
Phone: 559-587-1100