Provider Demographics
NPI:1750570875
Name:USHA IDNANI MD
Entity type:Organization
Organization Name:USHA IDNANI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDNANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-842-3854
Mailing Address - Street 1:34052 LA PLAZA ST
Mailing Address - Street 2:STE 105
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-0000
Mailing Address - Country:US
Mailing Address - Phone:949-842-3854
Mailing Address - Fax:949-388-3597
Practice Address - Street 1:34052 LA PLAZA ST
Practice Address - Street 2:STE 105
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-0000
Practice Address - Country:US
Practice Address - Phone:949-842-3854
Practice Address - Fax:949-388-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty