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General NPI Number Information
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NPI Number | 1245243146
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Entity Type | Individual
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Provider Name | PADMA KHANCHUSTAMBHAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 35400 BOB HOPE DR SUITE # 209
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1772
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Country | US
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Telephone | 760-699-7117
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Fax | 760-699-7750
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Provider Business Mailing Address
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Address Line | 36101 BOB HOPE DR STE. E-5 #117
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-2001
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Country | US
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Telephone | 760-464-2166
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Fax | 760-699-7750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A86478
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License Number State | CA
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