Provider Demographics
NPI:1528402260
Name:GANTA, JYOTSNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTSNA
Middle Name:S
Last Name:GANTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 TRUCKEE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-7320
Mailing Address - Country:US
Mailing Address - Phone:408-476-4762
Mailing Address - Fax:
Practice Address - Street 1:7111 S VIRGINIA ST # A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1115
Practice Address - Country:US
Practice Address - Phone:775-851-5700
Practice Address - Fax:775-851-5766
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20685207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine