Provider Demographics
NPI:1518036888
Name:BANDUKWALA, RAHIL ABDEMANNAN (DO)
Entity Type:Individual
Prefix:
First Name:RAHIL
Middle Name:ABDEMANNAN
Last Name:BANDUKWALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10625 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1908
Mailing Address - Country:US
Mailing Address - Phone:858-829-2385
Mailing Address - Fax:858-576-0954
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:SUITE 201
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-634-0064
Practice Address - Fax:760-334-2006
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 7863207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI08644Medicare UPIN