Provider Demographics
NPI:1295847689
Name:RANDERIA, KALYANI P (MD)
Entity Type:Individual
Prefix:MRS
First Name:KALYANI
Middle Name:P
Last Name:RANDERIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 E BEVERLY BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4317
Mailing Address - Country:US
Mailing Address - Phone:323-724-9767
Mailing Address - Fax:323-724-2722
Practice Address - Street 1:101 E BEVERLY BLVD STE 405
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4317
Practice Address - Country:US
Practice Address - Phone:323-724-9767
Practice Address - Fax:323-724-2722
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA045174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A451740Medicaid
CA00A451740Medicaid
CAF38041Medicare UPIN