1417688078 NPI number — SANJIV MIDHA MD A MEDICAL CORPORATION A PROFESSIONAL CORPORATION

Table of content: (NPI 1437180833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417688078 NPI number — SANJIV MIDHA MD A MEDICAL CORPORATION A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANJIV MIDHA MD A MEDICAL CORPORATION A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417688078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 PLUMAS ST STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95991-3453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-898-1201
Provider Business Mailing Address Fax Number:
530-898-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 EAST GRIDLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRIDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-674-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MIDHA
Authorized Official First Name:
SANJIV
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-674-2100

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com