Healthcare Provider Details

I. General information

NPI: 1154519254
Provider Name (Legal Business Name): SOWMYA ANANTHANARAYANAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13031 SUTTON ST
CERRITOS CA
90703-8751
US

IV. Provider business mailing address

13031 SUTTON ST
CERRITOS CA
90703-8751
US

V. Phone/Fax

Practice location:
  • Phone: 949-892-5357
  • Fax:
Mailing address:
  • Phone: 949-892-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 107221
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA 112431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: