Provider Demographics
NPI:1265495766
Name:MARWAHA, DIMPLE KA (DPM)
Entity Type:Individual
Prefix:
First Name:DIMPLE
Middle Name:KA
Last Name:MARWAHA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 MARKET PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4773
Mailing Address - Country:US
Mailing Address - Phone:925-866-8800
Mailing Address - Fax:925-866-8802
Practice Address - Street 1:1081 MARKET PL
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4773
Practice Address - Country:US
Practice Address - Phone:925-866-8800
Practice Address - Fax:925-866-8802
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE40852213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68030Medicare UPIN
000E40852Medicare ID - Type Unspecified