Provider Demographics
NPI:1093729436
Name:BAMBHANIA, RAMESH D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:D
Last Name:BAMBHANIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1139
Mailing Address - Country:US
Mailing Address - Phone:760-242-0600
Mailing Address - Fax:760-242-0606
Practice Address - Street 1:16003 TUSCOLA RD
Practice Address - Street 2:SUITE H
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-0825
Practice Address - Country:US
Practice Address - Phone:760-699-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37313ZMedicaid
CAWA45672BMedicare PIN
CAP00165085Medicare PIN
CAZZZ37313ZMedicaid
CAWA45672AMedicare PIN