Healthcare Provider Details

I. General information

NPI: 1144216862
Provider Name (Legal Business Name): PRERANA R SANGANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 WOODSIDE RD
WOODSIDE CA
94062-2443
US

IV. Provider business mailing address

2979 WOODSIDE RD
WOODSIDE CA
94062-2443
US

V. Phone/Fax

Practice location:
  • Phone: 650-851-4747
  • Fax: 650-851-4343
Mailing address:
  • Phone: 650-851-4747
  • Fax: 650-851-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA68348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: