Provider Demographics
NPI:1942685094
Name:NANDANWAR, DEEPMALA (MD)
Entity Type:Individual
Prefix:
First Name:DEEPMALA
Middle Name:
Last Name:NANDANWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 TALBERT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-5635
Mailing Address - Fax:714-378-5061
Practice Address - Street 1:9940 TALBERT AVE STE 100
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5062
Practice Address - Fax:714-378-5061
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1728442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty