1750570875 NPI number — USHA IDNANI MD

Table of content: SANTANA ST. REMY ARNP (NPI 1144819277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750570875 NPI number — USHA IDNANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USHA IDNANI MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1750570875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34052 LA PLAZA ST
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-842-3854
Provider Business Mailing Address Fax Number:
949-388-3597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34052 LA PLAZA ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
DANA POINT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92629-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-842-3854
Provider Business Practice Location Address Fax Number:
949-388-3597
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IDNANI
Authorized Official First Name:
USHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
949-842-3854

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A54509 , 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)





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