Provider Demographics
NPI:1003154246
Name:IDNANI, SUNITA RAVINDER (MD)
Entity Type:Individual
Prefix:
First Name:SUNITA
Middle Name:RAVINDER
Last Name:IDNANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19301 SURFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5588
Mailing Address - Country:US
Mailing Address - Phone:714-791-9540
Mailing Address - Fax:
Practice Address - Street 1:1703 TERMINO AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2124
Practice Address - Country:US
Practice Address - Phone:562-961-0210
Practice Address - Fax:562-961-0212
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56016208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics