Provider Demographics
NPI:1235251661
Name:KAMALAKAR RAMBHATLA, MD, INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KAMALAKAR RAMBHATLA, MD, INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMALAKAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAMBHATLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-442-3700
Mailing Address - Street 1:3580 SANTA ANITA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2455
Mailing Address - Country:US
Mailing Address - Phone:626-442-3700
Mailing Address - Fax:626-442-3710
Practice Address - Street 1:3580 SANTA ANITA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2455
Practice Address - Country:US
Practice Address - Phone:626-442-3700
Practice Address - Fax:626-442-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32691207R00000X
207RP1001X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00081949OtherRAILROAD MEDICARE
CAZZZ311861OtherBLUE SHIELD
CA00A326910Medicaid
CA00A326910Medicaid
CAZZZ311861OtherBLUE SHIELD