Provider Demographics
NPI:1518374354
Name:GARANI S. NADARAJA, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GARANI S. NADARAJA, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARANI
Authorized Official - Middle Name:SHIRANTHANA
Authorized Official - Last Name:NADARAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-432-6005
Mailing Address - Street 1:480 FILLMORE ST
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:744 52ND ST
Practice Address - Street 2:MULTISPECIALTY CLINIC
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1810
Practice Address - Country:US
Practice Address - Phone:510-428-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105932261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical