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General NPI Number Information
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NPI Number | 1922448836
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Entity Type | Organization
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Legal Business Name | CATHEDRAL MEDICAL INC.
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 2226 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-1825
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Country | US
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Telephone | 323-266-4446
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Fax | 323-266-4447
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Provider Business Mailing Address
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Address Line | 2226 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-1825
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Country | US
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Telephone | 323-266-4446
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Fax | 323-266-4447
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VIKRAM KOTHANDARAMAN
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Credential | MD
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Telephone | 323-266-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A91809
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License Number State | CA
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