Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 036-110940 | IL |
NPI | 1497741417 |
---|---|
Provider Name | Venkatraman Sadanand |
First Address | Loma Linda, CA 92354-2804 |
Second Address | Loma Linda, CA 92354-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 18/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-110940 | (05) | IL |