Provider Demographics
NPI:1104986165
Name:WADHWANI, VINITA (MD)
Entity type:Individual
Prefix:
First Name:VINITA
Middle Name:
Last Name:WADHWANI
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 1:700 STILL BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831
Mailing Address - Country:US
Mailing Address - Phone:916-427-8161
Mailing Address - Fax:916-422-2307
Practice Address - Street 1:1400 CELESTE DRIVE
Practice Address - Street 2:CRESTWOOD MANNOR
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:916-422-5856
Practice Address - Fax:916-422-2307
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A3207202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A320720Medicaid
E34149Medicare UPIN
CA00A320720Medicare ID - Type Unspecified