Provider Demographics
NPI:1063694917
Name:GURUSWAMY, RAVINDRAKUMAR G (M D, MPH)
Entity type:Individual
Prefix:
First Name:RAVINDRAKUMAR
Middle Name:G
Last Name:GURUSWAMY
Suffix:
Gender:M
Credentials:M D, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:626-775-3200
Mailing Address - Fax:
Practice Address - Street 1:1500 E. DUARTE ROAD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-256-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55765208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherFIRST HEALTH COMMERCIAL
NC5909641Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
VA1063694917Medicaid
VA356060OtherANTHEM
VA10035018OtherSENTARA/OPTIMA
VA2180857OtherUHC/MAMSI
VAPAROtherVA PREMIER HEALTH
VA-028OtherTRICARE
NC09641OtherNC BC/BS
VA1100455OtherUSA MANAGED CARE
VA9372153OtherAETNA
VA9433489OtherCIGNA
VAPAROtherVA HEALTH NETWORK
VA1100455OtherUSA MANAGED CARE
NC5909641Medicaid