Provider Demographics
NPI:1619234960
Name:BAVISETTY, SUMATI (MD)
Entity Type:Individual
Prefix:
First Name:SUMATI
Middle Name:
Last Name:BAVISETTY
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5601 DE SOTO AVE
Mailing Address - Street 2:HOSPITALIST OFFICE, 2ND FLOOR
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6701
Mailing Address - Country:US
Mailing Address - Phone:818-482-5333
Mailing Address - Fax:818-719-2414
Practice Address - Street 1:1818 N ORANGE GROVE AVE
Practice Address - Street 2:SUITE # 204
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3028
Practice Address - Country:US
Practice Address - Phone:909-620-7200
Practice Address - Fax:909-620-5800
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA120743207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine