Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A56016 | CA |
NPI | 1003154246 |
---|---|
Provider Name | Sunita Ravinder Idnani |
First Address | Huntington Beach, CA 92648-5588 |
Second Address | Long Beach, CA 90804-2124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2013 |
Last Update Date | 23/01/2013 |