Active NPI
Meena Suresh Gurbani, MD
- Pediatrics Physician
- San Bernardino, CA
National Provider Identifier
1518015494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A55112
- Practice address
- 1505 W 17TH St
San Bernardino, CA 92411-1202 - Phone
- (909) 887-6494
- Fax
- (909) 887-6043
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A55112 | CA | Primary |
Addresses
Primary practice location
1505 W 17TH St
San Bernardino, CA 92411-1202
Mailing address
685 Carnegie Dr.
Suite 230
San Bernardino, CA 92408
Phone (909) 890-0407
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A551120 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A55112 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Verras Pediatrics PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Tucker, GA
- NPI 1881809937
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352937600000",
"number": "1518015494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "685 CARNEGIE DR.",
"address_2": "SUITE 230",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "92408",
"telephone_number": "909-890-0407",
"fax_number": "909-890-0575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 W 17TH ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924111202",
"telephone_number": "909-887-6494",
"fax_number": "909-887-6043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GURBANI",
"first_name": "MEENA",
"middle_name": "SURESH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2012-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A55112",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A551120",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.