Provider Demographics
NPI:1669433009
Name:JASTI, ANIL (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:
Last Name:JASTI
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE STE 180
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0303
Practice Address - Country:US
Practice Address - Phone:916-536-2408
Practice Address - Fax:916-536-2465
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25876207R00000X
ND11558207R00000X
CAC135254207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR844477031OtherBCBS-GRANTS PASS
OR270045Medicaid
OR838334037OtherBCBS-ROSEBURG
ORP00342100OtherRR MEDICARE
OR838366035OtherBCBS-MCMINNVILLE
OR858463038OtherBCBS-MEDFORD
OR858464041OtherBCBS-SPRINGFIELD
OR270045Medicaid
ORI38947Medicare UPIN
OR858463038OtherBCBS-MEDFORD
ORR132326Medicare PIN
OR858463038OtherBCBS-MEDFORD