Healthcare Provider Details

I. General information

NPI: 1457597973
Provider Name (Legal Business Name): CLINICA MEDICA CATHEDRAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-1825
US

IV. Provider business mailing address

2226 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-1825
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-9898
  • Fax: 213-389-9897
Mailing address:
  • Phone: 213-389-9898
  • Fax: 213-389-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: VIKRAM KOTHANDARAMAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 213-389-9898