Provider Demographics
NPI:1073556064
Name:KOTHANDARAMAN, PREMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PREMA
Middle Name:
Last Name:KOTHANDARAMAN
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 1:51 N 5TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3711
Mailing Address - Country:US
Mailing Address - Phone:626-358-1970
Mailing Address - Fax:
Practice Address - Street 1:51 N 5TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3711
Practice Address - Country:US
Practice Address - Phone:626-358-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82019207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology