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General NPI Number Information
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NPI Number | 1790701118
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Entity Type | Organization
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Legal Business Name | FREMONT PSYCHIATRY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 722 MOWRY AVE
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City | FREMONT
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State | CA
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Zip | 94536-4115
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Country | US
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Telephone | 510-494-9313
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Fax | 510-494-9991
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Provider Business Mailing Address
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Address Line | 722 MOWRY AVE
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City | FREMONT
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State | CA
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Zip | 94536-4115
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Country | US
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Telephone | 510-494-9313
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Fax | 510-494-9991
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BHUPINDER SINGH WARAICH
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Credential | M.D.
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Telephone | 510-494-9313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G67904
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A53968
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License Number State | CA
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