Healthcare Provider Details

I. General information

NPI: 1467446013
Provider Name (Legal Business Name): PARAKRAMA T CHANDRASOMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LINDA VISTA AVE
PASADENA CA
91105-1237
US

IV. Provider business mailing address

405 LINDA VISTA AVE
PASADENA CA
91105-1237
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-4600
  • Fax: 323-226-5927
Mailing address:
  • Phone: 323-226-4600
  • Fax: 323-226-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA34284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: