Basic Information
| Provider Information | |||||||||
| NPI: | 1265417455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUBBARAO | ||||||||
| FirstName: | DILIPKUMAR | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43839 N 15TH STREET WEST | ||||||||
| Address2: | HIGH DESERT MEDICAL CORP. | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619455984 | ||||||||
| FaxNumber: | 6619513360 | ||||||||
| Practice Location | |||||||||
| Address1: | 43839 15TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619455984 | ||||||||
| FaxNumber: | 6619513360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 78621 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3121291 | 01 | MEDICAID WELFARE | OTHER | J30323 | 01 | BLUE SHIELD HMO BLUE | OTHER | 130323 | 01 | MEDICARE B | OTHER | J30323 | 01 | BLUE SHIELD INDEMNITY | OTHER | W1010450 | 01 | CIGNA HEALTH PLAN | OTHER | 0026740002 | 01 | CIGNA PAL ID | OTHER | 597515 | 01 | FIRST HEALTH | OTHER | J30323 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 3121291 | 05 | MA | MEDICAID | 4532386 | 01 | AETNA US HEALTHCARE | OTHER | 26893 | 01 | HEALTH START | OTHER | 3548163 | 01 | CIGNA HEALTHSOURCE | OTHER | 784201 | 01 | MVP HEALTH CARE | OTHER |