MEDICARE: USHA IDNANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A54509	CA

General Provider Information

NPI Number	:	1750570875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USHA IDNANI MD

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

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

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. USHA IDNANI
Credential	:	MD
Telephone Number	:	949-842-3854

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/08/2008

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