Inderpreet Rathore
Individual provider Active NPI Family Medicine Physician · McClellan Park, CA
NPI 1659501872 · NPPES record last updated Apr 3, 2014
Key facts
- NPI
- 1659501872
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301094635 (MI)
- Practice address
- 5342 Dudley Blvd., MC: 111/MCC
VA Clinic, McClellan
McClellan Park, CA 95652-1012 - Phone
- (916) 561-7400
- NPI assigned
- Jul 22, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170721002778 | CA | Order and Referring Only - Family Practice |
2365712445 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301094635 | MI | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301094635 | MI | Yes |
Addresses
Primary practice location
5342 Dudley Blvd., MC: 111/MCC
VA Clinic, McClellan
McClellan Park, CA 95652-1012
Mailing address
5342 Dudley Blvd., MC: 111/MCC
VA Clinic, McClellan
McClellan Park, CA 95652-1012
Phone (916) 561-7400
Other providers in McClellan Park, CA
All providers in McClellan Park, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.