Provider Demographics
NPI:1851582860
Name:SAPRA, RANJAN (MD)
Entity Type:Individual
Prefix:
First Name:RANJAN
Middle Name:
Last Name:SAPRA
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 1:11190 WARNER AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4019
Mailing Address - Country:US
Mailing Address - Phone:714-432-7500
Mailing Address - Fax:714-432-7520
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4019
Practice Address - Country:US
Practice Address - Phone:714-432-7500
Practice Address - Fax:714-432-7520
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35672207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A356722Medicaid
A84800Medicare UPIN
CAA35672Medicare PIN