Healthcare Provider Details

I. General information

NPI: 1083835995
Provider Name (Legal Business Name): SUDHA GOVINDARAJAN M D A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 W BEVERLY BLVD
MONTEBELLO CA
90640-2310
US

IV. Provider business mailing address

2614 W BEVERLY BLVD
MONTEBELLO CA
90640-2310
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-8181
  • Fax: 323-724-9725
Mailing address:
  • Phone: 323-728-8181
  • Fax: 323-724-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUDHA GOVINDARAJAN
Title or Position: PRESIDENT
Credential: MD.
Phone: 323-728-8181