Provider Demographics
NPI:1548201650
Name:WADHWA, PARVINDAR
Entity Type:Individual
Prefix:
First Name:PARVINDAR
Middle Name:
Last Name:WADHWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 W ROMNEYA DR
Mailing Address - Street 2:STE B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1818
Mailing Address - Country:US
Mailing Address - Phone:714-778-8484
Mailing Address - Fax:714-758-9197
Practice Address - Street 1:1781 W ROMNEYA DR
Practice Address - Street 2:STE B
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1818
Practice Address - Country:US
Practice Address - Phone:714-778-8484
Practice Address - Fax:714-758-9197
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30802207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26240Medicare UPIN
CAWA30802OMedicare ID - Type Unspecified