Provider Demographics
NPI:1366197956
Name:RAMESH MOOLANI, MD INC
Entity type:Organization
Organization Name:RAMESH MOOLANI, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MOOLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-745-1031
Mailing Address - Street 1:855 THIRD AVE STE 3330
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1350
Mailing Address - Country:US
Mailing Address - Phone:619-745-1031
Mailing Address - Fax:619-745-1032
Practice Address - Street 1:855 THIRD AVE STE 3330
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1350
Practice Address - Country:US
Practice Address - Phone:619-745-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437272010Medicaid