Provider Demographics
NPI:1447506779
Name:ADESHARA, PREETI VISHAL KUMAR (MBBS)
Entity type:Individual
Prefix:
First Name:PREETI
Middle Name:VISHAL KUMAR
Last Name:ADESHARA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0822
Mailing Address - Country:US
Mailing Address - Phone:951-549-0900
Mailing Address - Fax:951-278-2848
Practice Address - Street 1:2071 COMPTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881
Practice Address - Country:US
Practice Address - Phone:951-549-0900
Practice Address - Fax:951-278-2848
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine