Individual
DR. VISHVANATH V DATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
PETTIS MEMORIAL VA HOSPITAL, 11201, BENTON ST, LOMA LINDA, CA 92357-0001
(909) 825-7084
Mailing address
619 S SCOUT TRL, ANAHEIM, CA 92807-4756
(714) 974-1174
(714) 974-9390
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
A35366
CA
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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