Provider Demographics
NPI:1407128275
Name:RANDHAWA, RUPINDER
Entity Type:Individual
Prefix:DR
First Name:RUPINDER
Middle Name:
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CLAUS RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9711
Mailing Address - Country:US
Mailing Address - Phone:209-557-6342
Mailing Address - Fax:
Practice Address - Street 1:1501 CLAUS RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9711
Practice Address - Country:US
Practice Address - Phone:209-558-4700
Practice Address - Fax:209-557-6388
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-0607252084N0400X
CAA1400732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology