Provider Demographics
NPI:1447341995
Name:SWENSON, VINA K (MD)
Entity type:Individual
Prefix:DR
First Name:VINA
Middle Name:K
Last Name:SWENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VINA
Other - Middle Name:K
Other - Last Name:AGRAWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097
Mailing Address - Country:US
Mailing Address - Phone:530-842-2062
Mailing Address - Fax:530-842-2160
Practice Address - Street 1:1501 S OREGON ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097
Practice Address - Country:US
Practice Address - Phone:530-842-2062
Practice Address - Fax:530-842-2160
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731890Medicaid