Provider Demographics
NPI:1912285677
Name:VENKATADRIAGARAM, SUNDARARAJAN
Entity Type:Individual
Prefix:
First Name:SUNDARARAJAN
Middle Name:
Last Name:VENKATADRIAGARAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SUNDARARAJAN
Other - Middle Name:
Other - Last Name:V
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1215 N OLIVE DR
Mailing Address - Street 2:UNIT 404
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2765
Mailing Address - Country:US
Mailing Address - Phone:951-255-0106
Mailing Address - Fax:
Practice Address - Street 1:1215 N OLIVE DR
Practice Address - Street 2:UNIT 404
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2765
Practice Address - Country:US
Practice Address - Phone:951-255-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program