Healthcare Provider Details

I. General information

NPI: 1295773422
Provider Name (Legal Business Name): SANJOY BANERJEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 COMPTON AVE SUITE 102
CORONA CA
92881-7282
US

IV. Provider business mailing address

2097 COMPTON AVE SUITE 102
CORONA CA
92881-7282
US

V. Phone/Fax

Practice location:
  • Phone: 951-735-7246
  • Fax: 951-268-9516
Mailing address:
  • Phone: 951-735-7246
  • Fax: 951-268-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA90939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: