Provider Demographics
NPI:1649492166
Name:RASILA, KANWALDEEP KAUR (MD)
Entity type:Individual
Prefix:DR
First Name:KANWALDEEP
Middle Name:KAUR
Last Name:RASILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANWALDEEP
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2702 LOW CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9771
Practice Address - Country:US
Practice Address - Phone:707-427-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0710207RH0003X
CAC54884207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85624713Medicaid