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General NPI Number Information
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NPI Number | 1205817681
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Entity Type | Individual
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Provider Name | ANIL RAGHUNATH GARDE MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 6405 DAY ST
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City | RIVERSIDE
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State | CA
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Zip | 92507-0901
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Country | US
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Telephone | 951-697-5669
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Fax | 951-697-5445
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Provider Business Mailing Address
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Address Line | 3660 ARLINGTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-3912
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Country | US
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Telephone | 951-782-3045
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Fax | 951-274-0608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A25189
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License Number State | CA
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