Provider Demographics
NPI:1750356176
Name:ARIATHURAI, SUNDERA V (MD)
Entity type:Individual
Prefix:
First Name:SUNDERA
Middle Name:V
Last Name:ARIATHURAI
Suffix:
Gender:M
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:P.O. BOX 10668
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-3668
Mailing Address - Country:US
Mailing Address - Phone:818-241-2901
Mailing Address - Fax:818-241-2946
Practice Address - Street 1:720 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1712
Practice Address - Country:US
Practice Address - Phone:818-500-5885
Practice Address - Fax:818-241-2946
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA336012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A336010Medicaid
CAA33601AMedicare ID - Type Unspecified
CA00A336010Medicaid