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General NPI Number Information
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NPI Number | 1205139094
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Entity Type | Organization
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Legal Business Name | KALYANI RANDERIA, M.D. INC
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 101 E BEVERLY BLVD STE 405
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City | MONTEBELLO
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State | CA
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Zip | 90640-4317
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Country | US
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Telephone | 323-724-9767
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Fax | 323-724-2722
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Provider Business Mailing Address
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Address Line | 101 E BEVERLY BLVD STE 405
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City | MONTEBELLO
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State | CA
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Zip | 90640-4317
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Country | US
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Telephone | 323-724-9767
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Fax | 323-724-2722
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KALYANI RANDERIA
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Credential | M.D.
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Telephone | 323-724-9767
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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 | A45174
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License Number State | CA
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