Healthcare Provider Details

I. General information

NPI: 1508907874
Provider Name (Legal Business Name): INDUS HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 N GAREY AVE STE 100
POMONA CA
91767
US

IV. Provider business mailing address

2740 N GAREY AVE STE 100
POMONA CA
91767-1800
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-2300
  • Fax: 909-469-2472
Mailing address:
  • Phone: 909-623-2300
  • Fax: 909-469-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA95984
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA95984
License Number StateCA

VIII. Authorized Official

Name: DR. AMIT REENU PALIWAL
Title or Position: CEO
Credential: MD MBA MPH
Phone: 909-235-6770