Provider Demographics
NPI:1770525446
Name:WARREN, VENKAT (MD)
Entity type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:
Last Name:WARREN
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 1:925 E SAN ANTONIO DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2210
Mailing Address - Country:US
Mailing Address - Phone:562-423-1126
Mailing Address - Fax:562-423-2333
Practice Address - Street 1:925 E SAN ANTONIO DR
Practice Address - Street 2:SUITE 12
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2210
Practice Address - Country:US
Practice Address - Phone:562-423-1126
Practice Address - Fax:562-423-2333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30187207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A30187Medicaid
CA00A30187Medicaid
CAA84059Medicare UPIN