Provider Demographics
NPI:1669523759
Name:DURGA MEDICAL CORPORATION
Entity type:Organization
Organization Name:DURGA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANYASI
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-925-6657
Mailing Address - Street 1:850 E LATHAM AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-925-6657
Mailing Address - Fax:951-929-0907
Practice Address - Street 1:850 E LATHAM AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-925-6657
Practice Address - Fax:951-929-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70985310400000X, 207Q00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709850Medicaid
CAZZZ03765ZMedicare PIN
CA00A709850Medicaid