Provider Demographics
NPI:1124681580
Name:MURUGAN, HEMALATHA
Entity type:Individual
Prefix:
First Name:HEMALATHA
Middle Name:
Last Name:MURUGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 VILLA DEL LAGO DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5974
Mailing Address - Country:US
Mailing Address - Phone:425-404-0966
Mailing Address - Fax:
Practice Address - Street 1:1131 W 6TH ST STE 150
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1116
Practice Address - Country:US
Practice Address - Phone:909-482-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA176363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine