Provider Demographics
NPI:1336107648
Name:GANAPAVARAPU, SREEKANTH (MD)
Entity Type:Individual
Prefix:
First Name:SREEKANTH
Middle Name:
Last Name:GANAPAVARAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18144 OUTER HWY 18
Mailing Address - Street 2:STE 200
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2212
Mailing Address - Country:US
Mailing Address - Phone:760-242-7777
Mailing Address - Fax:760-242-0487
Practice Address - Street 1:18564 US HIGHWAY 18
Practice Address - Street 2:SUITE 105
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2312
Practice Address - Country:US
Practice Address - Phone:760-242-7777
Practice Address - Fax:760-242-0487
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82967208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A829670Medicaid
CAH98538Medicare UPIN
CA00A829670Medicaid