Provider Demographics
NPI:1538285754
Name:SWAMI, MEENAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MEENAL
Middle Name:
Last Name:SWAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 POMERADO RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2435
Mailing Address - Country:US
Mailing Address - Phone:858-487-8333
Mailing Address - Fax:858-487-0856
Practice Address - Street 1:15525 POMERADO ROAD
Practice Address - Street 2:SUITE B-1
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2435
Practice Address - Country:US
Practice Address - Phone:858-487-8333
Practice Address - Fax:858-487-0856
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100061208000000X
NVLL1469390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100061OtherCALIFORNIA LICENSE
CAFM0337596OtherDEA CERTIFICATE