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General NPI Number Information
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NPI Number | 1265601199
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Entity Type | Organization
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Legal Business Name | RAM MUDIYAM MD INC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 11190 WARNER AVE SUITE 310
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4019
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Country | US
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Telephone | 714-979-2401
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Fax | 714-966-0837
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Provider Business Mailing Address
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Address Line | 11190 WARNER AVE SUITE 310
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4019
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Country | US
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Telephone | 714-979-2401
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Fax | 714-966-0837
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. RAM MUDIYAM
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Credential | MD
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Telephone | 714-979-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A39174
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License Number State | CA
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