Provider Demographics
NPI:1710090766
Name:SANKARAM, RALLABHANDI (MD)
Entity Type:Individual
Prefix:
First Name:RALLABHANDI
Middle Name:
Last Name:SANKARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-0000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:11100 WARNER AVE STE 218
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-641-9696
Practice Address - Fax:714-641-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA25687207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A256871Medicaid
CA00A256871Medicaid
A24539Medicare UPIN