Provider Demographics
NPI:1497029078
Name:VISWANATH, RITU JAIN (MD)
Entity Type:Individual
Prefix:
First Name:RITU
Middle Name:JAIN
Last Name:VISWANATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RITU
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10573 W PICO BLVD # 822
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2333
Mailing Address - Country:US
Mailing Address - Phone:310-571-5015
Mailing Address - Fax:
Practice Address - Street 1:10573 W PICO BLVD # 822
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2333
Practice Address - Country:US
Practice Address - Phone:310-571-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120655207R00000X
CAA125466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14W11OtherBLUE CROSS BLUE SHIELD
FLHX896ZMedicare PIN