Provider Demographics
NPI:1033367388
Name:DURVASULA, RAMANI S (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAMANI
Middle Name:S
Last Name:DURVASULA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 STATE UNIVERSITY DRIVE
Mailing Address - Street 2:CSULA - KING HALL
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032
Mailing Address - Country:US
Mailing Address - Phone:310-435-8010
Mailing Address - Fax:323-343-2281
Practice Address - Street 1:5151 STATE UNIVERSITY DRIVE
Practice Address - Street 2:CSULA - KING HALL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032
Practice Address - Country:US
Practice Address - Phone:310-435-8010
Practice Address - Fax:323-343-2281
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical