Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 00A357430 | CA |
Y | 208600000X | Surgeon | 00A357430 | CA |
N | 2086S0102X | Surgical Critical Care | 00A357430 | CA |
N | 2086S0129X | Vascular Surgeon | 00A357430 | CA |
NPI | 1104933985 |
---|---|
Provider Name | Appannagari Gnanadev |
First Address | Redlands, CA 92373 |
Second Address | Colton, CA 92324-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 30/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A27892 | (02) | |
GR0079700 | (05) | CA |