Provider Demographics
NPI:1124015987
Name:GOVINDARAJAN, GOPAL (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:
Last Name:GOVINDARAJAN
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:DR
Other - First Name:RAJAGOPALAN
Other - Middle Name:
Other - Last Name:GOVINDARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E. BEVERLY BLVD.
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-728-8181
Mailing Address - Fax:323-724-9725
Practice Address - Street 1:1640 W. THIRD ST.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-483-1251
Practice Address - Fax:213-483-8577
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30202207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A302020Medicaid
CAA26006Medicare UPIN
CA00A302020Medicaid