Healthcare Provider Details

I. General information

NPI: 1407529753
Provider Name (Legal Business Name): SUDESHNA GHOSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

IV. Provider business mailing address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-8711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA190681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: