Shamala Md Physician Professional Corporation | |
555 Knowles Drive Suite 109 Los Gatos CA 95032 | |
(408) 370-0200 | |
(408) 370-0202 |
Full Name | Shamala Md Physician Professional Corporation |
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Speciality | Family Medicine |
Location | 555 Knowles Drive, Los Gatos, California |
Authorized Official Name and Position | Shamala Mohanasundaram (M.D.) |
Authorized Official Contact | 4083700200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Shamala Md Physician Professional Corporation 555 Knowles Drive Suite 109 Los Gatos CA 95032 Ph: (408) 370-0200 | Shamala Md Physician Professional Corporation 555 Knowles Drive Suite 109 Los Gatos CA 95032 Ph: (408) 370-0200 |
NPI Number | 1568752483 |
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Provider Enumeration Date | 04/12/2011 |
Last Update Date | 09/30/2015 |
Medicare PECOS PAC ID | 6901081660 |
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Medicare Enrollment ID | O20110425000437 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568752483 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | A112811 (California) | Primary |
Provider Name | Shamala Mohanasundaram |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1063608743 PECOS PAC ID: 6800071564 Enrollment ID: I20110425000451 |
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