Provider Demographics
NPI:1932147626
Name:KESAVALU, RAMESH C (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:C
Last Name:KESAVALU
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 1:1500S CENTRAL AVE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3853
Mailing Address - Country:US
Mailing Address - Phone:818-291-4010
Mailing Address - Fax:818-291-4058
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-291-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83127207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A831270Medicaid
CADA710ZMedicare PIN
CAWA83127AMedicare PIN
DA710YMedicare PIN
CAWA83127BMedicare PIN
CA00A831270Medicaid