Provider Demographics
NPI:1285062463
Name:RAI, SUDHA
Entity type:Individual
Prefix:MRS
First Name:SUDHA
Middle Name:
Last Name:RAI
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 1:7510 W SUNSET BLVD
Mailing Address - Street 2:#221
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3408
Mailing Address - Country:US
Mailing Address - Phone:213-507-9580
Mailing Address - Fax:
Practice Address - Street 1:17703 DE ORO PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-9069
Practice Address - Country:US
Practice Address - Phone:213-507-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist