Provider Demographics
NPI:1831511229
Name:SWAMINATHA V GURUDEVAN, MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SWAMINATHA V GURUDEVAN, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SWAMINATHA
Authorized Official - Middle Name:V
Authorized Official - Last Name:GURUDEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-956-4710
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:SUITE 1050W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-956-4710
Mailing Address - Fax:310-997-0398
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 1050W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-956-4710
Practice Address - Fax:310-997-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70212207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265525174Medicare NSC