MEDICARE: DR. SANJIV GIRISH FALDU 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
1	207RC0000X	Cardiovascular Disease Physician	MA05729100	NJ
2	207RC0000X	Cardiovascular Disease Physician	34489	AZ
3	207RC0000X	Cardiovascular Disease Physician	C166929	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P0136891	OTHER	AZ	MEDICARE PTAN

General Provider Information

NPI Number	:	1619973393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJIV GIRISH FALDU M.D.

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:	ATTN CREDENTIALING/PAYER ENROLLMENT
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 SISTER MARY COLUMBA DR FL 1
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-4327
Country	:	US
Telephone Number	:	530-528-6150
Fax Number	:	530-528-6196

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	02/27/2020

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