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General NPI Number Information
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NPI Number | 1356714745
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Entity Type | Organization
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Legal Business Name | EXCEL KIDNEY CARE INC A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 1144 NORMAN DR STE 303
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City | MANTECA
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State | CA
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Zip | 95336-5925
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Country | US
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Telephone | 209-888-4340
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Fax | 209-888-4371
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Provider Business Mailing Address
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Address Line | 1140 NORMAN DR STE 104
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City | MANTECA
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State | CA
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Zip | 95336-5900
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Country | US
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Telephone | 209-943-0851
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. RANDEEP S BAJWA
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Credential | M.D.
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Telephone | 209-825-2047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 3692662
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License Number State | CA
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