Provider Demographics
NPI:1558389536
Name:NATH, BADRI NONAVINKERE (MD)
Entity Type:Individual
Prefix:
First Name:BADRI
Middle Name:NONAVINKERE
Last Name:NATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39700 BOB HOPE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3267
Mailing Address - Country:US
Mailing Address - Phone:760-773-2882
Mailing Address - Fax:
Practice Address - Street 1:39700 BOB HOPE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-773-2882
Practice Address - Fax:760-773-2680
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA37768207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377680Medicare ID - Type Unspecified
CAA88428Medicare UPIN