Healthcare Provider Details

I. General information

NPI: 1366443665
Provider Name (Legal Business Name): JYOTI PANICKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31180 ROAD 72
VISALIA CA
93291-9672
US

IV. Provider business mailing address

31180 ROAD 72
VISALIA CA
93291-9672
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number199028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: