Provider Demographics
NPI:1801199864
Name:MONTERREY PARK MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTERREY PARK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RHEUMATOLOGIST/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMACHANDRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-458-8401
Mailing Address - Street 1:629 W VERMONT AVE
Mailing Address - Street 2:APT 14B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805
Mailing Address - Country:US
Mailing Address - Phone:951-367-9631
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20958363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty