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General NPI Number Information
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NPI Number | 1083835995
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Entity Type | Organization
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Legal Business Name | SUDHA GOVINDARAJAN M D A PROFESSIONAL CORP
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2614 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2310
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Country | US
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Telephone | 323-728-8181
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Fax | 323-724-9725
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Provider Business Mailing Address
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Address Line | 2614 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2310
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Country | US
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Telephone | 323-728-8181
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Fax | 323-724-9725
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUDHA GOVINDARAJAN
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Credential | MD.
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Telephone | 323-728-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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