Provider Demographics
NPI:1033409644
Name:PATHAK, SWATI (MD)
Entity Type:Individual
Prefix:DR
First Name:SWATI
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SWATI
Other - Middle Name:
Other - Last Name:PATHAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:165 SAINT DOMINICS DR STE 201
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7802
Practice Address - Country:US
Practice Address - Phone:209-823-2347
Practice Address - Fax:209-823-1408
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269843208D00000X
CAC160212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice