Provider Demographics
NPI:1588642516
Name:PADMANABHAN, MADRAS K (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:MADRAS
Middle Name:K
Last Name:PADMANABHAN
Suffix:
Gender:M
Credentials:MD FACC
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Mailing Address - Street 1:10515 BALBOA BLVD
Mailing Address - Street 2:#290
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6343
Mailing Address - Country:US
Mailing Address - Phone:818-832-5777
Mailing Address - Fax:818-832-5779
Practice Address - Street 1:10515 BALBOA BLVD
Practice Address - Street 2:#290
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6343
Practice Address - Country:US
Practice Address - Phone:818-832-5777
Practice Address - Fax:818-832-5779
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-03-04
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Provider Licenses
StateLicense IDTaxonomies
CAA31106207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A311060Medicaid
CACJ422AMedicare PIN