Provider Demographics
NPI:1972829729
Name:GANESH MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GANESH MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-946-4600
Mailing Address - Street 1:15982 TUSCOLA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2111
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
Practice Address - Country:US
Practice Address - Phone:760-946-4600
Practice Address - Fax:760-946-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCA504540261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A504540Medicaid
CAF03259Medicare UPIN