Healthcare Provider Details

I. General information

NPI: 1497893309
Provider Name (Legal Business Name): PONNAMMA CHENANDA, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

101 S 1ST ST #1000
BURBANK CA
91502-1938
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-5000
  • Fax: 661-951-4328
Mailing address:
  • Phone: 818-845-6206
  • Fax: 818-845-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA84213
License Number StateCA

VIII. Authorized Official

Name: DR. PONNAMMA M. CHENANDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-860-0899