Provider Demographics
NPI:1568449122
Name:KORULA, SHIRLEY RACHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:RACHEL
Last Name:KORULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4339 STATE UNIVERSITY DR
Mailing Address - Street 2:DIAGNOSTIC CENTER OF SOUTHERN CALIFORNIA
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-4220
Mailing Address - Country:US
Mailing Address - Phone:323-222-8090
Mailing Address - Fax:323-222-3018
Practice Address - Street 1:4339 STATE UNIVERSITY DR
Practice Address - Street 2:DIAGNOSTIC CENTER OF SOUTHERN CALIFORNIA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-4220
Practice Address - Country:US
Practice Address - Phone:323-222-8090
Practice Address - Fax:323-222-3018
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-08-29
Provider Licenses
StateLicense IDTaxonomies
CAA39721207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
A85325Medicare UPIN