Basic Information
| Provider Information | |||||||||
| NPI: | 1063694917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GURUSWAMY | ||||||||
| FirstName: | RAVINDRAKUMAR | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M. D., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 512185 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900510185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267753200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. DUARTE ROAD | ||||||||
| Address2: | |||||||||
| City: | DUARTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262564673 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | C55765 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | FIRST HEALTH COMMERCIAL | OTHER | 5909641 | 05 | NC | MEDICAID | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 1063694917 | 05 | VA | MEDICAID | 356060 | 01 | VA | ANTHEM | OTHER | 10035018 | 01 | VA | SENTARA/OPTIMA | OTHER | 2180857 | 01 | VA | UHC/MAMSI | OTHER | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | -028 | 01 | VA | TRICARE | OTHER | 09641 | 01 | NC | NC BC/BS | OTHER | 1100455 | 01 | VA | USA MANAGED CARE | OTHER | 9372153 | 01 | VA | AETNA | OTHER | 9433489 | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER |