Provider Demographics
NPI:1932637550
Name:RAMBARRAN, INDRA
Entity Type:Individual
Prefix:
First Name:INDRA
Middle Name:
Last Name:RAMBARRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1303
Mailing Address - Country:US
Mailing Address - Phone:832-597-2644
Mailing Address - Fax:
Practice Address - Street 1:7332 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1303
Practice Address - Country:US
Practice Address - Phone:832-597-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO251C00000XMedicaid