Provider Demographics
NPI:1598769846
Name:GUGGA, JARNAIL S (MD)
Entity Type:Individual
Prefix:
First Name:JARNAIL
Middle Name:S
Last Name:GUGGA
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 1:1532 SAN BERNARDINO AVE STE B7
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3559
Mailing Address - Country:US
Mailing Address - Phone:909-301-4041
Mailing Address - Fax:909-301-4042
Practice Address - Street 1:1532 SAN BERNARDINO AVE STE B7
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-301-4041
Practice Address - Fax:909-301-4042
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2023-11-13
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-28
Provider Licenses
StateLicense IDTaxonomies
CAA31418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314180Medicaid
CAW5835Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA00A314180Medicaid