Provider Demographics
NPI:1164789350
Name:RAJINDER SINGH RANDHAWA
Entity Type:Organization
Organization Name:RAJINDER SINGH RANDHAWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:RANDHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:916-715-2480
Mailing Address - Street 1:7720 TENNIS CT
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7720 TENNIS CT
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4667
Practice Address - Country:US
Practice Address - Phone:916-715-2480
Practice Address - Fax:916-721-9137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50081273R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No305S00000XManaged Care OrganizationsPoint of Service