Basic Information
| Provider Information | |||||||||
| NPI: | 1487698585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATILAL | ||||||||
| FirstName: | JAY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 W VINE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952423731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093333135 | ||||||||
| FaxNumber: | 2093333132 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 W VINE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952423731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093333135 | ||||||||
| FaxNumber: | 2093333132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A66236 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.