Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | A36528 | CA |
NPI | 1043393986 |
---|---|
Provider Name | Rajapuram Ravindra Kumar |
First Address | Merced, CA 95348 |
Second Address | Merced, CA 95348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 01/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A365282 | (05) | CA |
A28115 | (02) | CA |