Active NPI
Pradeep Gidwani, MD
- Pediatrics Physician
- San Diego, CA
National Provider Identifier
1063613909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A76477
- Practice address
- 3160 Camino del Rio S
Suite115
San Diego, CA 92108-3813 - Phone
- (619) 281-2291
- NPI assigned
- May 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A76477 | CA | Primary |
Addresses
Primary practice location
3160 Camino del Rio S
Suite115
San Diego, CA 92108-3813
Mailing address
4818 Barbarossa Dr
San Diego, CA 92115-3732
Phone (619) 886-6562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A76477 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063613909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4818 BARBAROSSA DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921153732",
"telephone_number": "619-886-6562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3160 CAMINO DEL RIO S",
"address_2": "SUITE115",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083813",
"telephone_number": "619-281-2291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIDWANI",
"first_name": "PRADEEP",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A76477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.