Provider Demographics
NPI:1689940694
Name:RAM, SWAYTA M (MD)
Entity Type:Individual
Prefix:
First Name:SWAYTA
Middle Name:M
Last Name:RAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWAYTA
Other - Middle Name:M
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4867 W SUNSET BLVD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5969
Mailing Address - Country:US
Mailing Address - Phone:323-240-9842
Mailing Address - Fax:
Practice Address - Street 1:4867 W SUNSET BLVD DEPT OF
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-240-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA130077207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program