1568610483 NPI number — DR. NINA NANDA VADECHA M.D.

Table of content: DR. NINA NANDA VADECHA M.D. (NPI 1568610483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568610483 NPI number — DR. NINA NANDA VADECHA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VADECHA
Provider First Name:
NINA
Provider Middle Name:
NANDA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1568610483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3610 SHADOW GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91107-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-471-6192
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1255 WEST ARROW HWY
Provider Second Line Business Practice Location Address:
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Provider Business Practice Location Address City Name:
SAN DIMAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-780-1277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A101002 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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