Provider Demographics
NPI:1053493577
Name:IYER, SHANTHI RAVI
Entity Type:Individual
Prefix:
First Name:SHANTHI
Middle Name:RAVI
Last Name:IYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANTHI
Other - Middle Name:
Other - Last Name:RAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17323 YVETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1242
Mailing Address - Country:US
Mailing Address - Phone:323-725-7372
Mailing Address - Fax:323-837-9980
Practice Address - Street 1:5426,EAST OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:CITY OF COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90002
Practice Address - Country:US
Practice Address - Phone:323-725-7372
Practice Address - Fax:323-837-9980
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH33780Medicare UPIN