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12998 Hesperia Rd Ste 204 Victorville CA 92395-8317 | |
| (760) 780-4960 | |
| (760) 780-4964 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 12998 Hesperia Rd Ste 204, Victorville, California |
| Authorized Official Name and Position | Vir Kumar Nanda (PRESIDENT) |
| Authorized Official Contact | 7607804960 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12998 Hesperia Rd Ste 204 Victorville CA 92395-8317 Ph: (760) 780-4960 | 12998 Hesperia Rd Ste 204 Victorville CA 92395-8317 Ph: (760) 780-4960 |
| NPI Number | 1710981733 |
|---|---|
| Provider Enumeration Date | 06/08/2005 |
| Last Update Date | 08/29/2022 |
| Medicare PECOS PAC ID | 4981799129 |
|---|---|
| Medicare Enrollment ID | O20071002000725 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710981733 | NPI | - | NPPES |
| 0862090001 | Other | MEDICARE DME PROVIDER | |
| 5628485 | Other | OTHER ID NUMBER | |
| 00A388830 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A388830 (California) | Secondary |
| 207RH0003X | Internal Medicine - Hematology & Oncology | A388830 (California) | Primary |
| Provider Name | Vir K Nanda |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1386841963 PECOS PAC ID: 1850294935 Enrollment ID: I20040127001214 |
| Provider Name | Cortney D Franz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174077507 PECOS PAC ID: 7810285152 Enrollment ID: I20161019001419 |
| Provider Name | Soe T Maunglay |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1093864373 PECOS PAC ID: 0547361214 Enrollment ID: I20180412001365 |
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