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NPI Code Detail

MEDICARE: DR. NALLINI GNANADESIGAN M.D.

MEDICARE: DR. NALLINI GNANADESIGAN M.D.
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
1207RG0300XGeriatric Medicine (Internal Medicine) PhysicianC42560CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WC42560BOTHERCAPPIN #1
2WC42560COTHERCAPPIN #2
3C42560OTHERCACA LICENSE #

General Provider Information

NPI Number : 1467480020
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NALLINI GNANADESIGAN M.D.
Provider Business Mailing Address
First Line : 4322 VANALDEN AVE
Second Line :
City : TARZANA
State : CA
Zip : 91356-5520
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7150 TAMPA AVE
Second Line :
City : RESEDA
State : CA
Zip : 91335-3700
Country : US
Telephone Number : 818-757-4447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 03/07/2023

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