Healthcare Provider Details

I. General information

NPI: 1386099570
Provider Name (Legal Business Name): ANVINDERJEET SINGH PANNU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MERCY AVE STE 301
MERCED CA
95340-8367
US

IV. Provider business mailing address

333 MERCY AVE
MERCED CA
95340-8319
US

V. Phone/Fax

Practice location:
  • Phone: 209-564-3500
  • Fax:
Mailing address:
  • Phone: 209-564-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: