Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A38830 | CA |
NPI | 1023037215 |
---|---|
Provider Name | Dr. Shashi D Ganti |
First Address | Porterville, CA 93257-3383 |
Second Address | Porterville, CA 93257-3383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 10/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A388301 | (05) | CA |
A64424 | (02) | CA |