Healthcare Provider Details

I. General information

NPI: 1184593303
Provider Name (Legal Business Name): MY DIABETES TUTOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W GRANGEVILLE BLVD
HANFORD CA
93230-2861
US

IV. Provider business mailing address

515 W GRANGEVILLE BLVD
HANFORD CA
93230-2861
US

V. Phone/Fax

Practice location:
  • Phone: 844-623-0999
  • Fax: 844-306-5999
Mailing address:
  • Phone: 844-623-0999
  • Fax: 844-306-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: PREM SAHASRANAM
Title or Position: FOUNDER/ CMO
Credential: MD
Phone: 559-587-1100