Healthcare Provider Details

I. General information

NPI: 1073569604
Provider Name (Legal Business Name): RAVI GAREHGRAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 TOWN CENTER DR STE 170
RANCHO CUCAMONGA CA
91730-0361
US

IV. Provider business mailing address

10590 TOWN CENTER DR STE 170
RANCHO CUCAMONGA CA
91730-0361
US

V. Phone/Fax

Practice location:
  • Phone: 909-483-0000
  • Fax: 909-483-0001
Mailing address:
  • Phone: 909-483-0000
  • Fax: 909-483-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD63584
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: