Basic Information
| Provider Information | |||||||||
| NPI: | 1275810921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALCHIRA | ||||||||
| FirstName: | RAMYA | ||||||||
| MiddleName: | RAMESH | ||||||||
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| Credential: | MD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 25775 MCBEAN PKWY | ||||||||
| Address2: | STE 215 | ||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913553708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617535464 | ||||||||
| FaxNumber: | 6617535466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2011 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A118929 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A118929 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RN0300X | A118929 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00A1189290 | 05 | CA | MEDICAID |