Provider Demographics
NPI:1114944824
Name:MAHESHWARI, ANOOP (MD)
Entity Type:Individual
Prefix:
First Name:ANOOP
Middle Name:
Last Name:MAHESHWARI
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 1:1157 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4364
Mailing Address - Country:US
Mailing Address - Phone:951-737-5809
Mailing Address - Fax:951-848-6923
Practice Address - Street 1:1157 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882
Practice Address - Country:US
Practice Address - Phone:951-737-5809
Practice Address - Fax:951-848-6923
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45841207RP1001X
CAA045841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A458411Medicaid
CA05D0939366OtherCLIA
CAA45841OtherMEDICAL BOARD LIC
CAA45841OtherMEDICAL BOARD LIC
CAF57130Medicare UPIN
CA00A458410Medicare ID - Type Unspecified