Provider Demographics
NPI:1851370480
Name:PANDYA, ASHVIN C (MD)
Entity Type:Individual
Prefix:MR
First Name:ASHVIN
Middle Name:C
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASHVIN
Other - Middle Name:C
Other - Last Name:PANDYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:37 SAINT MICHAEL
Mailing Address - Street 2:
Mailing Address - City:MONARCH BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:760-937-2347
Mailing Address - Fax:760-872-3197
Practice Address - Street 1:407 WEST LINE ST.
Practice Address - Street 2:SUITE #7
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514
Practice Address - Country:US
Practice Address - Phone:760-873-3561
Practice Address - Fax:760-872-3197
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A456841Medicaid
CA00A456841Medicaid