Basic Information
| Provider Information | |||||||||
| NPI: | 1043741184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDHU | ||||||||
| FirstName: | NAVPREET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3569 ROUND BARN CIR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954035781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075838800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34 MARK WEST SPRINGS RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954031766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073033600 | ||||||||
| FaxNumber: | 7073033611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2017 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | A157843 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | A157843 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1213860 | 01 | CA | AMERICAN BOARD OF FAMILY MEDICINE | OTHER | A157843 | 01 | CA | STATE MEDICAL LICENSE | OTHER |