Provider Demographics
NPI:1144216862
Name:SANGANI, PRERANA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PRERANA
Middle Name:R
Last Name:SANGANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2443
Mailing Address - Country:US
Mailing Address - Phone:650-851-4747
Mailing Address - Fax:650-851-4343
Practice Address - Street 1:2979 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94062-2443
Practice Address - Country:US
Practice Address - Phone:650-851-4747
Practice Address - Fax:650-851-4343
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A683480Medicaid
CA00A683480Medicaid
CA00A683482Medicare ID - Type Unspecified