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General NPI Number Information
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NPI Number | 1336792662
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Entity Type | Individual
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Provider Name | PREETHI CONJEEVARAM SELVAKUMAR MD
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1120 DELBON AVE
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City | TURLOCK
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State | CA
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Zip | 95382-2021
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Country | US
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Telephone | 209-722-4842
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 CUSTOMER CARE WAY
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City | ATWATER
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State | CA
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Zip | 95301-5167
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Country | US
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Telephone | 209-722-4842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A190095
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License Number State | CA
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