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General NPI Number Information
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NPI Number | 1437570926
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Entity Type | Individual
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Provider Name | SUBHADRA RAMANATHAN M.S.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2013
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 2195 CLUB CENTER DR STE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4170
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Country | US
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Telephone | 909-835-1870
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Fax | 909-835-1780
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Provider Business Mailing Address
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Address Line | 2195 CLUB CENTER DR STE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4170
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Country | US
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Telephone | 909-835-1870
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Fax | 909-835-1780
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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 | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | GC000272
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License Number State | CA
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