Provider Demographics
NPI:1992327084
Name:GNANADEV, RAJA ALBERTO APPANNAGARI (MS, MD)
Entity type:Individual
Prefix:DR
First Name:RAJA
Middle Name:ALBERTO APPANNAGARI
Last Name:GNANADEV
Suffix:
Gender:M
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MANZANITA RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7267
Mailing Address - Country:US
Mailing Address - Phone:909-921-4109
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:909-921-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program