Provider Demographics
NPI:1689844045
Name:NEVILLE V. UDWADIA, M.D., INC.
Entity Type:Organization
Organization Name:NEVILLE V. UDWADIA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:VIRAF
Authorized Official - Last Name:UDWADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-422-6011
Mailing Address - Street 1:224 SAN JOSE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3931
Mailing Address - Country:US
Mailing Address - Phone:831-422-6011
Mailing Address - Fax:831-422-6569
Practice Address - Street 1:224 SAN JOSE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3931
Practice Address - Country:US
Practice Address - Phone:831-422-6011
Practice Address - Fax:831-422-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91956261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03716ZMedicare PIN
CAI49876Medicare UPIN