Provider Demographics
NPI:1306858782
Name:RANJAN K SAPRA M.D A MEDICAL CORPORATION
Entity type:Organization
Organization Name:RANJAN K SAPRA M.D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANJAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAPRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-432-7500
Mailing Address - Street 1:11190 WARNER AVE #405
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-432-7500
Mailing Address - Fax:714-432-7520
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-432-7500
Practice Address - Fax:714-432-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35672207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A356722Medicaid
CAA84800Medicare UPIN
CA00A356722Medicaid