Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. SUDJAI ITSARA, M.D.
Deactivated Sole ProprietorDR. SUDJAI ITSARA, M.D. is a Pediatrics healthcare provider located in MODESTO, California. NPI 1699767400 is deactivated in the NPPES registry. Verify at CMS.
Pediatrics · MODESTO, CA
This NPI has been deactivated.
The record was deactivated on March 23, 2006.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1699767400
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Aug 17, 2005 (0.5972602739726 yrs)
- Last Updated
- Jul 8, 2007
- Deactivated
- Mar 23, 2006
- License
-
A38082 (CA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
305 E GRANGER AVE STE 201MODESTO, CA, 953504344Browse CA providers · Browse ZIP 95350
- Phone
- 2095263336
- Fax
- 2095263316
- Primary Specialty
-
Pediatrics
208000000X
Other Pediatrics Providers in MODESTO, CA
| Name | Credential | NPI |
|---|---|---|
| DR. SARAH KOCH | MD | 1932196458 |
| MR. JAMES COSTELLO | PA | 1801883236 |
| DR. JOSE LIMON-OLIVARES | MD | 1326035726 |
| DR. PHILIP BAUMAN | MD | 1457348872 |
| MISS DONNA SILVA | NP | 1154318590 |
| ELIZABETH BAILEY | NP | 1477540300 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.