| Sitaraman Jyotheeswaran Md Facp A Medical Corporation | |
|
520 N Prospect Ave Suite # 304 Redondo Beach CA 90277-3041 | |
| (310) 798-2006 | |
| (310) 379-6199 |
| Full Name | Sitaraman Jyotheeswaran Md Facp A Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 520 N Prospect Ave, Redondo Beach, California |
| Authorized Official Name and Position | Sitaraman Jyotheeswaran (OWNER) |
| Authorized Official Contact | 3107982006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sitaraman Jyotheeswaran Md Facp A Medical Corporation 520 N Prospect Avenue Suite # 304 Redondo Beach CA 90277 Ph: (310) 798-2006 | Sitaraman Jyotheeswaran Md Facp A Medical Corporation 520 N Prospect Ave Suite # 304 Redondo Beach CA 90277-3041 Ph: (310) 798-2006 |
| NPI Number | 1346536968 |
|---|---|
| Provider Enumeration Date | 06/22/2011 |
| Last Update Date | 06/22/2011 |
| Medicare PECOS PAC ID | 6103096839 |
|---|---|
| Medicare Enrollment ID | O20110907000917 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346536968 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Sitaraman Jyotheeswaran |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1952469272 PECOS PAC ID: 0648377614 Enrollment ID: I20070525000546 |
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