Provider Demographics
NPI:1821364688
Name:GEETA VENKATASUBRAMANIAM MD INC
Entity Type:Organization
Organization Name:GEETA VENKATASUBRAMANIAM MD INC
Other - Org Name:GEETA VENKAT M.D.INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-3551
Mailing Address - Street 1:26732 CROWN VALLEY PKWY
Mailing Address - Street 2:STE 431
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6306
Mailing Address - Country:US
Mailing Address - Phone:949-364-3551
Mailing Address - Fax:949-364-1921
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:STE 431
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-3551
Practice Address - Fax:949-364-1921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEETA VENKATASUBRAMANIAM M.D.INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center