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General NPI Number Information
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NPI Number | 1417965831
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Entity Type | Individual
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Provider Name | SULAGNA CHAKRABORTY CHAKRABURTY SAITTA M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1245 16TH ST STE 202
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City | SANTA MONICA
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State | CA
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Zip | 90404-1240
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Country | US
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Telephone | 310-794-7274
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G88947
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | G88947
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License Number State | CA
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