Provider Demographics
NPI:1750498408
Name:MATHARU, JOGINDER S (MD)
Entity Type:Individual
Prefix:
First Name:JOGINDER
Middle Name:S
Last Name:MATHARU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1383 E HERNDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3302
Mailing Address - Country:US
Mailing Address - Phone:559-449-8004
Mailing Address - Fax:559-449-8037
Practice Address - Street 1:1383 E HERNDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3302
Practice Address - Country:US
Practice Address - Phone:559-449-8004
Practice Address - Fax:559-449-8037
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA28563207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28563Medicare UPIN