Basic Information
| Provider Information | |||||||||
| NPI: | 1003154246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IDNANI | ||||||||
| FirstName: | SUNITA | ||||||||
| MiddleName: | RAVINDER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19301 SURFVIEW DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926485588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147919540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1703 TERMINO AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908042124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629610210 | ||||||||
| FaxNumber: | 5629610212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2013 | ||||||||
| LastUpdateDate: | 01/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A56016 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.