Healthcare Provider Details

I. General information

NPI: 1770394702
Provider Name (Legal Business Name): SOFIA ANDRES RAMALINGAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DEL AMO ST
REDONDO BEACH CA
90277-3050
US

IV. Provider business mailing address

1740 MAPLE ST
SANTA MONICA CA
90405-2726
US

V. Phone/Fax

Practice location:
  • Phone: 310-374-5706
  • Fax:
Mailing address:
  • Phone: 310-710-1761
  • Fax:

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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: