Provider Demographics
NPI:1235420399
Name:PHADNIS, SWAPNA VAYUVEGULA (MD)
Entity Type:Individual
Prefix:
First Name:SWAPNA
Middle Name:VAYUVEGULA
Last Name:PHADNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWAPNA
Other - Middle Name:
Other - Last Name:VAYUVEGULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 W ROUTE 66
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:626-914-0174
Mailing Address - Fax:626-914-2008
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:SUITE 212
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-914-0174
Practice Address - Fax:626-914-2008
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208D00000X207Q00000X
CAA135159208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine