Provider Demographics
NPI:1043235195
Name:RANDHAWA, GURINDER K (MD)
Entity Type:Individual
Prefix:DR
First Name:GURINDER
Middle Name:K
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:970 DEWING AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4291
Mailing Address - Country:US
Mailing Address - Phone:925-283-3122
Mailing Address - Fax:925-283-3140
Practice Address - Street 1:970 DEWING AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4291
Practice Address - Country:US
Practice Address - Phone:925-283-3122
Practice Address - Fax:925-283-3140
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G674170Medicaid
CA00G674171Medicare PIN
CA00G674170Medicaid
CAF96149Medicare UPIN