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General NPI Number Information
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NPI Number | 1245275841
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Entity Type | Individual
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Provider Name | SOMASUNDARAM RAJENDRAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1600 W 24TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1411
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Country | US
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Telephone | 719-546-4083
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Fax | 719-546-4762
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Provider Business Mailing Address
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Address Line | 1600 W 24TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1411
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Country | US
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Telephone | 719-546-4083
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Fax | 719-546-4762
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 36415
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License Number State | CO
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