Provider Demographics
NPI:1659477792
Name:SENIGALA, RADHARANI K
Entity Type:Individual
Prefix:DR
First Name:RADHARANI
Middle Name:K
Last Name:SENIGALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3304
Mailing Address - Country:US
Mailing Address - Phone:213-744-3945
Mailing Address - Fax:213-744-3944
Practice Address - Street 1:2829 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3304
Practice Address - Country:US
Practice Address - Phone:213-744-3945
Practice Address - Fax:213-744-3944
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809BMedicare ID - Type UnspecifiedHUDSON
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER