Healthcare Provider Details

I. General information

NPI: 1730173386
Provider Name (Legal Business Name): PARAKRAMA T CHANDRASOMA MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/22/2014
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: 626-304-1055
  • Fax: 323-441-8183
Mailing address:
  • Phone: 626-304-1055
  • Fax: 323-441-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PARAKRAMA T CHANDRASOMA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-409-4600