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General NPI Number Information
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NPI Number | 1104066570
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Entity Type | Organization
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Legal Business Name | NEWBORN SPECIAL CARE MEDICAL GROUP
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 1720 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-2414
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Country | US
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Telephone | 323-268-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1359
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City | SAN CLEMENTE
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State | CA
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Zip | 92674-1359
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Country | US
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Telephone | 949-492-3514
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Fax | 949-366-2390
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Authorized Official
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Title or Position | PRINCIPAL OFFICER/DIRECTOR/OWNER
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Name | SUMITHRA KOMMAREDDY
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Credential |
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Telephone | 949-492-3514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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