MEDICARE: DR. ROY AJIT NAMBUDRIPAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A101715	CA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A101715	CA

General Provider Information

NPI Number	:	1376732867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY AJIT NAMBUDRIPAD M.D.

Provider Business Mailing Address
First Line	:	6714 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3410
Country	:	US
Telephone Number	:	714-523-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	6714 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3410
Country	:	US
Telephone Number	:	714-523-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	08/31/2010

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