Basic Information
| Provider Information | |||||||||
| NPI: | 1619050572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUTHUKUMARAN | ||||||||
| FirstName: | ABIRAMI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8631 W 3RD ST | ||||||||
| Address2: | SUITE # 215 EAST, EAST TOWER, NEUROLOY CLINIC | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104236472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1220 MANNING AVE APT 14 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182700217 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | A80716 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | A80716 | 01 | CA | MEDICAL LICENSE | OTHER |