Provider Demographics
NPI:1184980930
Name:NEELAKANTAN RAMINENI MD, INC.
Entity type:Organization
Organization Name:NEELAKANTAN RAMINENI MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEELAKANTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-265-0504
Mailing Address - Street 1:4537 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4010
Mailing Address - Country:US
Mailing Address - Phone:619-265-0504
Mailing Address - Fax:619-265-8358
Practice Address - Street 1:4537 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4010
Practice Address - Country:US
Practice Address - Phone:619-265-0504
Practice Address - Fax:619-265-8358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A412890Medicaid
CAA41289Medicare PIN
CAA29346Medicare UPIN