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General NPI Number Information
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NPI Number | 1942007588
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Entity Type | Organization
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Legal Business Name | SUDHA RANI KAILAS LLC
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Dates
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Enumeration Date | 03/01/2025
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 413 GRANT AVE STE C
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City | SANTA FE
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State | NM
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Zip | 87501-1687
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Country | US
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Telephone | 505-428-9504
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Fax |
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Provider Business Mailing Address
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Address Line | 743 W MANHATTAN AVE APT B
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City | SANTA FE
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State | NM
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Zip | 87501-3792
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Country | US
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Telephone | 505-428-9504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUDHA KAILAS
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Credential | MD, PHD
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Telephone | 505-428-9504
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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