Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A90273 | CA |
N | 207R00000X | Internist | A90273 | CA |
N | 111NI0900X | Internist | A90273 | CA |
NPI | 1598703480 |
---|---|
Provider Name | Praveen Buddiga |
First Address | Fresno, CA 93729-6270 |
Second Address | Fresno, CA 93720-0357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 15/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1598703480 | (05) | CA |
CA115989 | MEDICARE PTAN (01) | |
CA115990 | MEDICARE PTAN (01) | CA |
GR0043790 | (05) | CA |