Healthcare Provider Details

I. General information

NPI: 1104933985
Provider Name (Legal Business Name): DEV APPANNAGARI GNANADEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE ARMC MODULAR # 3
COLTON CA
92324-1801
US

IV. Provider business mailing address

PO BOX 670
REDLANDS CA
92373-0221
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-6210
  • Fax: 909-580-1363
Mailing address:
  • Phone: 909-580-6210
  • Fax: 909-580-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number00A357430
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number00A357430
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00A357430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: