Provider Demographics
NPI:1821629650
Name:SANDEEP S WALIA, MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SANDEEP S WALIA, MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-393-2331
Mailing Address - Street 1:215 CHINA GRADE LOOP
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308
Mailing Address - Country:US
Mailing Address - Phone:661-393-2331
Mailing Address - Fax:661-393-6284
Practice Address - Street 1:215 CHINA GRADE LOOP
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308
Practice Address - Country:US
Practice Address - Phone:661-393-2331
Practice Address - Fax:661-393-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty