Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME90355 | FL |
NPI | 1194802124 |
---|---|
Provider Name | Dr. Amberpet Yesuraj Rathnam |
First Address | Parkland, FL 33076-3855 |
Second Address | Sunrise, FL 33313-2894 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B20525 | (02) | NY |