Provider Demographics
NPI:1689865503
Name:SRINIVASAN, RAMACHANDRAN (MD)
Entity Type:Individual
Prefix:
First Name:RAMACHANDRAN
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4722
Mailing Address - Country:US
Mailing Address - Phone:626-458-8401
Mailing Address - Fax:626-458-5606
Practice Address - Street 1:941 S ATLANTIC BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4722
Practice Address - Country:US
Practice Address - Phone:626-458-8401
Practice Address - Fax:626-458-5606
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25280207Q00000X, 207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A252800Medicaid
CAWA25280GMedicare PIN
CA00A252800Medicaid