Healthcare Provider Details

I. General information

NPI: 1316972425
Provider Name (Legal Business Name): PAULA R DHANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5685 MAIN STREET
KELSEYVILLE CA
95451
US

IV. Provider business mailing address

5685 MAIN ST
KELSEYVILLE CA
95451-8945
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-8733
  • Fax: 707-262-0313
Mailing address:
  • Phone: 707-263-8733
  • Fax: 707-279-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG62526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: