MEDICARE: JAI V GHATNEKAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	01052298	IN
2	208600000X	Surgery Physician	C42883	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DO365A	OTHER	CA	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083717268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAI V GHATNEKAR MD

Provider Business Mailing Address
First Line	:	PO BOX 2019
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92286-2019
Country	:	US
Telephone Number	:	760-362-3777
Fax Number	:	760-228-2151

Provider Business Practice Location Address
First Line	:	6601 WHITE FEATHER RD
Second Line	:	STE A4
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252-6607
Country	:	US
Telephone Number	:	760-366-6128
Fax Number	:	760-366-6130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	11/04/2010

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Directions to “ JAI V GHATNEKAR MD” Practice Location

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