Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A12842 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | 20A12842 | CA |
NPI | 1053687152 |
---|---|
Provider Name | Dimple Ajwani |
First Address | Sacramento, CA 95865-5228 |
Second Address | Roseville, CA 95661-3037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2012 |
Last Update Date | 24/08/2020 |