Provider Demographics
NPI:1902877301
Name:DARAWAL, ASSAD U (MD)
Entity Type:Individual
Prefix:MR
First Name:ASSAD
Middle Name:U
Last Name:DARAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:81893 DR CARREON BLVD
Mailing Address - Street 2:#1
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-342-8005
Mailing Address - Fax:760-342-5451
Practice Address - Street 1:81893 DR CARREON BLVD
Practice Address - Street 2:#1
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-342-8005
Practice Address - Fax:760-342-5451
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085630Medicaid
CA00A516020Medicaid
00A516020Medicare ID - Type Unspecified
CAZZZ1689732Medicare ID - Type Unspecified
CAGR0085630Medicaid