Provider Demographics
NPI:1558468942
Name:GANESH, NARESH J (MD)
Entity Type:Individual
Prefix:DR
First Name:NARESH
Middle Name:J
Last Name:GANESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15982 TUSCOLA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-946-4600
Mailing Address - Fax:760-946-1696
Practice Address - Street 1:15982 TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2111
Practice Address - Country:US
Practice Address - Phone:760-946-4600
Practice Address - Fax:760-946-1696
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA504540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA504540OtherLICENSE
CA00A504540Medicaid
CAA504540OtherLICENSE
CA00A504540Medicaid