Provider Demographics
NPI:1841253200
Name:SINGH, MADHULIKA D (PA-C)
Entity type:Individual
Prefix:
First Name:MADHULIKA
Middle Name:D
Last Name:SINGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1102
Mailing Address - Country:US
Mailing Address - Phone:909-599-9921
Mailing Address - Fax:909-592-3147
Practice Address - Street 1:150 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1102
Practice Address - Country:US
Practice Address - Phone:909-599-9921
Practice Address - Fax:909-592-3147
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP13437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPA13437BOtherPPIN
P31359Medicare UPIN