Provider Demographics
NPI:1295913705
Name:RAJENDRA H DWIVEDI M.D. INC
Entity type:Organization
Organization Name:RAJENDRA H DWIVEDI M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:DWIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD MS
Authorized Official - Phone:559-781-2403
Mailing Address - Street 1:623 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3212
Mailing Address - Country:US
Mailing Address - Phone:559-781-2403
Mailing Address - Fax:559-781-4334
Practice Address - Street 1:623 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-781-2403
Practice Address - Fax:559-781-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A337030261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337030Medicaid
CAA27224Medicare UPIN