Provider Demographics
NPI:1225094469
Name:DHANUKA, PROMILA (MD)
Entity Type:Individual
Prefix:
First Name:PROMILA
Middle Name:
Last Name:DHANUKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PROMILA
Other - Middle Name:
Other - Last Name:PROMILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 994190
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4190
Mailing Address - Country:US
Mailing Address - Phone:530-247-1425
Mailing Address - Fax:530-247-1533
Practice Address - Street 1:2145 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2531
Practice Address - Country:US
Practice Address - Phone:530-247-1425
Practice Address - Fax:530-247-1533
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95171207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225094469OtherBLUE SHIELD
CAA95171OtherMEDICAL LICENSE NUMBER
1225094469OtherBLUE CROSS
CA1225094469Medicaid