Provider Demographics
NPI:1518024405
Name:SABARATNAM, SEKILAR RUDRA (MD)
Entity Type:Individual
Prefix:
First Name:SEKILAR
Middle Name:RUDRA
Last Name:SABARATNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17709 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5604
Mailing Address - Country:US
Mailing Address - Phone:818-363-3121
Mailing Address - Fax:818-366-1728
Practice Address - Street 1:17709 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5604
Practice Address - Country:US
Practice Address - Phone:818-363-3121
Practice Address - Fax:818-366-1728
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZGR0007030Medicaid
CAWG28871COtherPIN
CAW3519Medicare ID - Type Unspecified
CAWG28871COtherPIN