Basic Information
| Provider Information | |||||||||
| NPI: | 1144331851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SATHYA | ||||||||
| FirstName: | RAAKESH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 959 E WALNUT ST | ||||||||
| Address2: | STE 120 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911061451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267951831 | ||||||||
| FaxNumber: | 6267952716 | ||||||||
| Practice Location | |||||||||
| Address1: | 959 E WALNUT ST | ||||||||
| Address2: | STE 120 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911061451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267955118 | ||||||||
| FaxNumber: | 6267952716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301088789 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | C155272 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | C155272 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1144331851 | 05 | MI | MEDICAID |