Provider Demographics
NPI:1619052271
Name:DUGGAL, EENA (MD)
Entity Type:Individual
Prefix:DR
First Name:EENA
Middle Name:
Last Name:DUGGAL
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 1:8019 JORGENSEN LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8200
Mailing Address - Country:US
Mailing Address - Phone:925-249-9999
Mailing Address - Fax:
Practice Address - Street 1:4456 BLACK AVE STE 100
Practice Address - Street 2:SUITE 6
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6147
Practice Address - Country:US
Practice Address - Phone:925-462-8100
Practice Address - Fax:925-426-2356
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69821Medicare UPIN
CAG69821Medicare UPIN