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General NPI Number Information
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NPI Number | 1669523759
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Entity Type | Organization
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Legal Business Name | DURGA MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 850 E LATHAM AVE SUITE 201
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City | HEMET
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State | CA
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Zip | 92543
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Country | US
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Telephone | 951-925-6657
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Fax | 951-929-0907
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Provider Business Mailing Address
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Address Line | 850 E LATHAM AVE SUITE 201
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City | HEMET
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State | CA
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Zip | 92543
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Country | US
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Telephone | 951-925-6657
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Fax | 951-929-0907
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANYASI R GANTA
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Credential | MD
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Telephone | 951-925-6657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | A70985
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A70985
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | A70985
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License Number State | CA
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