Provider Demographics
NPI:1821398884
Name:WADHWA, TARUN S
Entity Type:Individual
Prefix:
First Name:TARUN
Middle Name:S
Last Name:WADHWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2244
Mailing Address - Country:US
Mailing Address - Phone:760-351-3007
Mailing Address - Fax:760-351-3012
Practice Address - Street 1:3601 VISTA WAY STE 103
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:760-231-5800
Practice Address - Fax:760-231-5801
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist