Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A107471 | CA |
NPI | 1003127234 |
---|---|
Provider Name | Dr. Siva Venu Natarajan |
First Address | Hermosa Beach, CA 90254-1494 |
Second Address | Visalia, CA 93291-8543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 03/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FQ210Z | PTAN (01) | CA |
ZZZ16448Z | GROUP PTAN (01) | CA |