Provider Demographics
NPI:1265497283
Name:RANA, HAMENDRA T (MD)
Entity Type:Individual
Prefix:
First Name:HAMENDRA
Middle Name:T
Last Name:RANA
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 1:1913 E 17TH ST
Mailing Address - Street 2:#106
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8627
Mailing Address - Country:US
Mailing Address - Phone:714-547-6278
Mailing Address - Fax:714-547-3335
Practice Address - Street 1:1913 E 17TH ST
Practice Address - Street 2:#106
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8627
Practice Address - Country:US
Practice Address - Phone:714-547-6278
Practice Address - Fax:714-547-3335
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30625207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA306252Medicaid
CAOOA306252Medicaid
CAOOA306252Medicare ID - Type Unspecified