Healthcare Provider Details

I. General information

NPI: 1306825237
Provider Name (Legal Business Name): NATESAN SUBRAMANIAN RAMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W EATON AVE #B
TRACY CA
95376
US

IV. Provider business mailing address

530 W EATON AVE #B
TRACY CA
95376
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-9029
  • Fax: 209-833-9352
Mailing address:
  • Phone: 209-835-9029
  • Fax: 209-833-9352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA31206
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA31206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: