Healthcare Provider Details

I. General information

NPI: 1326430133
Provider Name (Legal Business Name): ANIRUDH MIRAKHUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD BLVD. DEPARTMENT OF RADIOLOGICAL SCIENCES
LOS ANGELES CA
90095-7437
US

IV. Provider business mailing address

757 WESTWOOD BLVD. SUITE 1638 (DEPARTMENT OF RADIOLOGICAL SCIENCES)
LOS ANGELES CA
90095
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8758
  • Fax: 310-267-2059
Mailing address:
  • Phone: 310-267-8758
  • Fax: 310-267-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: