Provider Demographics
NPI:1417576307
Name:BANIPAL MEDICAL CORP
Entity Type:Organization
Organization Name:BANIPAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMPLEDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-926-5272
Mailing Address - Street 1:19400 TURTLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3803
Mailing Address - Country:US
Mailing Address - Phone:818-926-5272
Mailing Address - Fax:
Practice Address - Street 1:355 E 21ST ST STE C
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4851
Practice Address - Country:US
Practice Address - Phone:818-926-5272
Practice Address - Fax:573-250-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty