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NPI Code Detail

MEDICARE: VANDHANA WADHWA MD

MEDICARE: VANDHANA WADHWA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician16790NV

General Provider Information

NPI Number : 1104911437
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANDHANA WADHWA MD
Provider Business Mailing Address
First Line : 12900 PARK PLAZA DR STE 150
Second Line :
City : CERRITOS
State : CA
Zip : 90703-9329
Country : US
Telephone Number : 562-977-4674
Fax Number : 562-741-4479
Provider Business Practice Location Address
First Line : 3041 E FLAMINGO RD STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-7447
Country : US
Telephone Number : 702-436-0835
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 09/21/2023

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