Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | A90635 | CA |
NPI | 1043425036 |
---|---|
Provider Name | Dr. Rajesh S Banker |
First Address | Newport Beach, CA 92663-3637 |
Second Address | Newport Beach, CA 92663-3637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 14/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BC027X | MEDICARE INDIVIDUAL PTAN ASSIGNED TO PREMIER CARDIOLOGY (01) | CA |