Individual
SANTHOSH AMBIKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5423 RENO CORPORATE DR., RENO, NV 89511-2250
(775) 329-0873
(775) 329-1026
Mailing address
5423 RENO CORPORATE DR, RENO, NV 89511-2250
(775) 329-0873
(775) 329-1026
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
16308
NV
207ZH0000X
Hematology (Pathology) Physician
16308
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417027608
GROUP NPI
VA
01
—
C05754
MEDICARE GROUP PTAN
VA
01
—
V113098
INDIVIDUAL PTAN
NV
01
—
VAA101126
MEDICARE PTAN
VA
01
—
VWCHGC
GROUP PTAN
NV
Enumeration date
04/12/2007
Last updated
05/22/2019
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