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General NPI Number Information
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NPI Number | 1346536968
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Entity Type | Organization
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Legal Business Name | SITARAMAN JYOTHEESWARAN MD FACP A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 520 N PROSPECT AVE SUITE # 304
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3041
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Country | US
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Telephone | 310-798-2006
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Fax | 310-379-6199
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Provider Business Mailing Address
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Address Line | 520 N PROSPECT AVENUE SUITE # 304
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City | REDONDO BEACH
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State | CA
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Zip | 90277
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Country | US
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Telephone | 310-798-2006
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Fax | 310-379-6199
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Authorized Official
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Title or Position | OWNER
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Name | SITARAMAN JYOTHEESWARAN
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Credential | M.D.
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Telephone | 310-798-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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