Basic Information
| Provider Information | |||||||||
| NPI: | 1699483925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUGGAL | ||||||||
| FirstName: | SHRUTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4502 DUNNWOOD DR | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957629307 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3280 WASHINGTON ST | ||||||||
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| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956675838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306226842 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.