Healthcare Provider Details

I. General information

NPI: 1154525335
Provider Name (Legal Business Name): SWATI PANSE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N STATE ST STE 1
SAN JACINTO CA
92583-6567
US

IV. Provider business mailing address

PO BOX 788
HEMET CA
92546-0788
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-6260
  • Fax: 951-765-2855
Mailing address:
  • Phone: 951-929-6260
  • Fax: 951-765-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC51794
License Number StateCA

VIII. Authorized Official

Name: SWATI PANSE
Title or Position: OWNER
Credential: MD
Phone: 951-654-4044