Provider Demographics
NPI:1427261924
Name:ANUPAM GARG MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ANUPAM GARG MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-688-0770
Mailing Address - Street 1:2918 FIFTH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5910
Mailing Address - Country:US
Mailing Address - Phone:619-688-0770
Mailing Address - Fax:619-688-0987
Practice Address - Street 1:2918 FIFTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5910
Practice Address - Country:US
Practice Address - Phone:619-688-0770
Practice Address - Fax:619-688-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065890Medicaid
CAGR0065890Medicaid