Provider Demographics
NPI:1528601218
Name:MY DIABETES TUTOR INC
Entity Type:Organization
Organization Name:MY DIABETES TUTOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHASRANAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-587-1100
Mailing Address - Street 1:PO BOX 1669
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1669
Mailing Address - Country:US
Mailing Address - Phone:559-587-1100
Mailing Address - Fax:559-587-9044
Practice Address - Street 1:515 W GRANGEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2861
Practice Address - Country:US
Practice Address - Phone:844-623-0999
Practice Address - Fax:844-306-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty