Provider Demographics
NPI:1609210830
Name:MATTU, RAMAN (MD)
Entity Type:Individual
Prefix:
First Name:RAMAN
Middle Name:
Last Name:MATTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMANDEEP
Other - Middle Name:S
Other - Last Name:LASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2302
Mailing Address - Country:US
Mailing Address - Phone:559-499-6500
Mailing Address - Fax:
Practice Address - Street 1:121 BARBOZA ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-1901
Practice Address - Country:US
Practice Address - Phone:559-655-5000
Practice Address - Fax:559-655-6818
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine