Healthcare Provider Details

I. General information

NPI: 1992294011
Provider Name (Legal Business Name): SANJAY S. RAO M.D., A MEDICAL CORPORATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 08/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 SIERRA CENTER PKWY
RENO NV
89511
US

IV. Provider business mailing address

PO BOX 18592
RENO NV
89511-0592
US

V. Phone/Fax

Practice location:
  • Phone: 775-393-2200
  • Fax:
Mailing address:
  • Phone: 775-657-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17410
License Number StateNV

VIII. Authorized Official

Name: SANJAY RAO
Title or Position: OWNER
Credential: MD
Phone: 619-708-7100