Healthcare Provider Details

I. General information

NPI: 1689753188
Provider Name (Legal Business Name): SURESH P RAO M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E CESAR E CHAVEZ AVE SUITE 125
LOS ANGELES CA
90033-2464
US

IV. Provider business mailing address

1701 E CESAR E CHAVEZ AVE SUITE 125
LOS ANGELES CA
90033-2464
US

V. Phone/Fax

Practice location:
  • Phone: 323-441-1122
  • Fax: 323-441-1172
Mailing address:
  • Phone: 323-441-1122
  • Fax: 323-441-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA63778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: