Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | ME90212 | FL |
NPI | 1003928565 |
---|---|
Provider Name | Dr. Muthukumar Vaidyaraman |
First Address | Porter Ranch, CA 91326-1112 |
Second Address | Porter Ranch, CA 91326-1112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 07/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115797 | (02) | FL |
270695400 | (05) | FL |
ME90212 | MD (01) | FL |