Healthcare Provider Details

I. General information

NPI: 1396767919
Provider Name (Legal Business Name): SUGUNA RS RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SU RAO MD

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81880 DR CARREON BLVD SUITE A103
INDIO CA
92201
US

IV. Provider business mailing address

75275 SANTA FE TRAIL
PALM DESERT CA
92211
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-2255
  • Fax: 760-342-2397
Mailing address:
  • Phone: 760-341-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC41903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: