Provider Demographics
NPI:1699849489
Name:BAJWA, RAVINDER S (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:S
Last Name:BAJWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE # L4640
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-0003
Mailing Address - Country:US
Mailing Address - Phone:805-652-6222
Mailing Address - Fax:805-652-6221
Practice Address - Street 1:300 HILLMONT AVE STE 502
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1651
Practice Address - Country:US
Practice Address - Phone:805-652-6222
Practice Address - Fax:805-652-6221
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85528207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A855280Medicaid
CA00A855280Medicaid