Provider Demographics
NPI:1952192353
Name:RANDHAWA, AMANDEEP KAUR
Entity type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 PASEO DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3809
Mailing Address - Country:US
Mailing Address - Phone:510-691-3701
Mailing Address - Fax:
Practice Address - Street 1:1435 N MCDOWELL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6548
Practice Address - Country:US
Practice Address - Phone:415-598-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031051207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine