Provider Demographics
NPI:1588642656
Name:GANDHOKE, RONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:GANDHOKE
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 1:2025 MORSE AVE.
Mailing Address - Street 2:DEPT. OF ANESTHESIA
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-223-0499
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVE.
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-223-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0261207L00000X
AZ29893207L00000X
CAA102183207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009R53OtherBC/BS
P00201183OtherRAILROAD MEDICARE
AZ879778Medicaid
NM201042281OtherPRESBYTERIAN HEALTH/SALUD
P00201183OtherRAILROAD MEDICARE
AZ879778Medicaid
NMPROVP13136OtherMOLINA
85031326801OtherCHAMPUS
CAP00832620Medicare PIN
85031326801OtherCHAMPUS
NMPROVP13136OtherMOLINA
345514602Medicare ID - Type Unspecified
AZ879778Medicaid
NM2054566Medicaid
CACD196YMedicare PIN