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General NPI Number Information
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NPI Number | 1417576307
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Entity Type | Organization
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Legal Business Name | BANIPAL MEDICAL CORP
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 355 E 21ST ST STE C
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4851
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Country | US
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Telephone | 818-926-5272
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Fax | 573-250-7382
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Provider Business Mailing Address
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Address Line | 19400 TURTLE RIDGE LN
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City | PORTER RANCH
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State | CA
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Zip | 91326-3803
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Country | US
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Telephone | 818-926-5272
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Fax |
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Authorized Official
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Title or Position | VASCULAR SURGEON
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Name | DR. SIMPLEDEEP BANIPAL
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Credential | MD
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Telephone | 818-926-5272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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