Provider Demographics
NPI:1821008111
Name:RAVIKUMAR, KALPANA (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:
Last Name:RAVIKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44215 15TH ST WEST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-945-4563
Mailing Address - Fax:661-945-2344
Practice Address - Street 1:44215 15TH ST WEST
Practice Address - Street 2:SUITE 114
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-945-4563
Practice Address - Fax:661-945-2344
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35711208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA250001569OtherRAILROAD MEDICARE
CAA35711OtherLICENSE
CA00A357110Medicaid
CA00A357110Medicaid