Healthcare Provider Details

I. General information

NPI: 1497029078
Provider Name (Legal Business Name): RITU JAIN VISWANATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITU JAIN MD

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE STE 228
TARZANA CA
91356-6157
US

IV. Provider business mailing address

10573 W PICO BLVD # 822
LOS ANGELES CA
90064-2333
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-5015
  • Fax:
Mailing address:
  • Phone: 310-571-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME120655
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA125466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: