1669649844 NPI number — DR. SUNIL JERAM ADVANI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669649844 NPI number — DR. SUNIL JERAM ADVANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADVANI
Provider First Name:
SUNIL
Provider Middle Name:
JERAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669649844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W ARBOR DR
Provider Second Line Business Mailing Address:
UCSD MEDICAL CENTER DEPT RADIOLOGY MC 8756
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-8756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-822-4364
Provider Business Mailing Address Fax Number:
858-822-7400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3855 HEALTH SCIENCES DR # 843
Provider Second Line Business Practice Location Address:
UCSD MOORES CANCER CENTER DEPT RADIATION ONCOLOGY
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92093-0843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-822-4364
Provider Business Practice Location Address Fax Number:
858-822-7400
Provider Enumeration Date:
05/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  A110025 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)