Provider Demographics
NPI:1568610483
Name:VADECHA, NINA NANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:NANDA
Last Name:VADECHA
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 1:3610 SHADOW GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2112
Mailing Address - Country:US
Mailing Address - Phone:714-471-6192
Mailing Address - Fax:
Practice Address - Street 1:1255 WEST ARROW HWY
Practice Address - Street 2:SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773
Practice Address - Country:US
Practice Address - Phone:800-780-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine