Provider Demographics
NPI:1891883674
Name:PANSE, SWATI (MD)
Entity Type:Individual
Prefix:
First Name:SWATI
Middle Name:
Last Name:PANSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWATI
Other - Middle Name:
Other - Last Name:PATWARDHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:621 N STATE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6567
Mailing Address - Country:US
Mailing Address - Phone:951-654-4044
Mailing Address - Fax:951-654-4144
Practice Address - Street 1:621 N STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6567
Practice Address - Country:US
Practice Address - Phone:951-654-4044
Practice Address - Fax:951-654-4144
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330882844OtherTIN