Basic Information
| Provider Information | |||||||||
| NPI: | 1932147626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KESAVALU | ||||||||
| FirstName: | RAMESH | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500S CENTRAL AVE 200 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912043853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182914010 | ||||||||
| FaxNumber: | 8182914058 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 W EULALIA ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912042849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182914010 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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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 | 207RR0500X | A83127 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 00A831270 | 05 | CA | MEDICAID |