Provider Demographics
NPI:1669493862
Name:POOLA, RAMAN SADASIVASWAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAN
Middle Name:SADASIVASWAMY
Last Name:POOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18523 CORWIN RD
Mailing Address - Street 2:STE H
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2338
Mailing Address - Country:US
Mailing Address - Phone:760-242-3000
Mailing Address - Fax:760-242-1802
Practice Address - Street 1:18523 CORWIN RD
Practice Address - Street 2:STE H
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2338
Practice Address - Country:US
Practice Address - Phone:760-242-3000
Practice Address - Fax:760-242-1802
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA376360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist