Provider Demographics
NPI:1194814731
Name:ASHISH K. WADHA MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ASHISH K. WADHA MD A MEDICAL CORPORATION
Other - Org Name:RANCHO EAR, NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-674-1165
Mailing Address - Street 1:12630 MONTE VISTA ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064
Mailing Address - Country:US
Mailing Address - Phone:858-674-1165
Mailing Address - Fax:858-674-9841
Practice Address - Street 1:12630 MONTE VISTA ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-674-1165
Practice Address - Fax:858-674-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75692207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI23342Medicare UPIN
CAW18283Medicare ID - Type UnspecifiedMEDICARE GROUP