Organization
MY DIABETES TUTOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREM SAHASRANAM MD (PRESIDENT)
(559) 587-1100
Entity
Organization
Contact information
Practice address
515 W GRANGEVILLE BLVD, HANFORD, CA 93230-2861
(844) 623-0999
(844) 306-5999
Mailing address
PO BOX 1669, HANFORD, CA 93232-1669
(559) 587-1100
(559) 587-9044
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
163WD0400X
Diabetes Educator Registered Nurse
—
—
174H00000X
Health Educator
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
732976
ADCES DIABETES EDUCATION ACCREDITATION PROGRAM (DEAP)
CA
Enumeration date
10/24/2019
Last updated
11/05/2025
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