Healthcare Provider Details

I. General information

NPI: 1831814748
Provider Name (Legal Business Name): SITASHI POUDYAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N. HOCKETT ST.
PORTERVILLE CA
93257
US

IV. Provider business mailing address

1701 E D ST APT 1314
ONTARIO CA
91764-5606
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 909-678-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: