Healthcare Provider Details

I. General information

NPI: 1528099264
Provider Name (Legal Business Name): PROMILA DHANUKA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 COURT ST
REDDING CA
96001-2531
US

IV. Provider business mailing address

PO BOX 994190
REDDING CA
96099-4190
US

V. Phone/Fax

Practice location:
  • Phone: 530-247-1425
  • Fax: 530-247-1533
Mailing address:
  • Phone: 530-247-1425
  • Fax: 530-247-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA95171
License Number StateCA

VIII. Authorized Official

Name: PROMILA DHANUKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-247-1425