Basic Information
| Provider Information | |||||||||
| NPI: | 1316464068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURTHY | ||||||||
| FirstName: | SOWMYA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | CARE COORDINATOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3424 WILSHIRE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239321226 | ||||||||
| FaxNumber: | 3239339808 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 SO LAFAYETTE PARK PLACE 3RD FLOOR | ||||||||
| Address2: | |||||||||
| City: | LA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900575400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239321226 | ||||||||
| FaxNumber: | 2133833146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2017 | ||||||||
| LastUpdateDate: | 08/24/2017 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.