Healthcare Provider Details

I. General information

NPI: 1962922708
Provider Name (Legal Business Name): SATHISH SUBRAMANIAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31625 DE PORTOLA RD STE 101
TEMECULA CA
92592-2770
US

IV. Provider business mailing address

FILE # 57326
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 951-501-4200
  • Fax: 951-900-3108
Mailing address:
  • Phone: 800-926-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number272094
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA199040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: