MEDICARE: FAMILY DOCTORS RAMANATHAN, PLLC

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1568754075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DOCTORS RAMANATHAN, PLLC

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	SUITE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	8475 S EASTERN AVE
Second Line	:	STE 204
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2862
Country	:	US
Telephone Number	:	702-616-9471
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. RAVI RAMANATHAN
Credential	:	M.D.
Telephone Number	:	702-616-9471

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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