1669433009 NPI number — ANIL JASTI MD

Table of content: ANIL JASTI MD (NPI 1669433009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669433009 NPI number — ANIL JASTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JASTI
Provider First Name:
ANIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669433009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 DATA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-7956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6555 COYLE AVE STE 180
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-0303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-536-2408
Provider Business Practice Location Address Fax Number:
916-536-2465
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD25876 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 11558 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: C135254 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 844477031 . This is a "BCBS-GRANTS PASS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 270045 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 838334037 . This is a "BCBS-ROSEBURG" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: P00342100 . This is a "RR MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 838366035 . This is a "BCBS-MCMINNVILLE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 858463038 . This is a "BCBS-MEDFORD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 858464041 . This is a "BCBS-SPRINGFIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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