Healthcare Provider Details

I. General information

NPI: 1366124893
Provider Name (Legal Business Name): MACHHINDRA BADUWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 E CARTMILL AVE
TULARE CA
93274-9610
US

IV. Provider business mailing address

1134 E CARTMILL AVE
TULARE CA
93274-9610
US

V. Phone/Fax

Practice location:
  • Phone: 559-686-9097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA207105
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351051275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: