MEDICARE: DR. SANYASI R GANTA 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A70985	CA
2	207Q00000X	Family Medicine Physician	A70985	CA

General Provider Information

NPI Number	:	1760547392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANYASI R GANTA M.D,

Provider Business Mailing Address
First Line	:	225 LAURSEN ST
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92543-4437
Country	:	US
Telephone Number	:	951-925-6657
Fax Number	:	951-929-0907

Provider Business Practice Location Address
First Line	:	225 LAURSEN ST
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92543-4437
Country	:	US
Telephone Number	:	951-925-6657
Fax Number	:	951-929-0907

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	04/21/2026

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