Provider Demographics
NPI:1477672590
Name:RAMAN NAMBISAN, MD, INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAMAN NAMBISAN, MD, INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PUNCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-460-3883
Mailing Address - Street 1:5575 W LAS POSITAS BLVD
Mailing Address - Street 2:270
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5801
Mailing Address - Country:US
Mailing Address - Phone:925-460-3883
Mailing Address - Fax:925-460-3859
Practice Address - Street 1:5575 W LAS POSITAS BLVD
Practice Address - Street 2:270
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5801
Practice Address - Country:US
Practice Address - Phone:925-460-3883
Practice Address - Fax:925-460-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA372122086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A37212Medicare ID - Type Unspecified
CAE57212Medicare UPIN