Provider Demographics
NPI:1205910882
Name:UDWADIA, NEVILLE VIRAF (MD)
Entity type:Individual
Prefix:
First Name:NEVILLE
Middle Name:VIRAF
Last Name:UDWADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FOREST RIDGE RD
Mailing Address - Street 2:TANGLEWOOD #58
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4138
Mailing Address - Country:US
Mailing Address - Phone:831-747-7990
Mailing Address - Fax:831-422-6569
Practice Address - Street 1:224-2 SAN JOSE STREET
Practice Address - Street 2:#2
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-422-6011
Practice Address - Fax:831-422-6569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91956207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1765836Medicaid
CAZZZ03716ZMedicare ID - Type Unspecified
CA1765836Medicaid