Provider Demographics
NPI:1972537736
Name:GHADIYA, MANSUKH RANCHHODBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:MANSUKH
Middle Name:RANCHHODBHAI
Last Name:GHADIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60770
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93386-0770
Mailing Address - Country:US
Mailing Address - Phone:661-215-4948
Mailing Address - Fax:855-677-5701
Practice Address - Street 1:2201 MOUNT VERNON AVE
Practice Address - Street 2:SUITE 211 A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3341
Practice Address - Country:US
Practice Address - Phone:661-215-4948
Practice Address - Fax:855-677-5701
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H73120Medicare UPIN
CA00A717590Medicare ID - Type Unspecified