Provider Demographics
NPI:1316900236
Name:DANDILLAYA, RAMPRASAD C (MD)
Entity type:Individual
Prefix:
First Name:RAMPRASAD
Middle Name:C
Last Name:DANDILLAYA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4505
Mailing Address - Country:US
Mailing Address - Phone:310-854-4995
Mailing Address - Fax:310-652-4053
Practice Address - Street 1:150 N ROBERTSON,
Practice Address - Street 2:SUITE 150
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-854-4995
Practice Address - Fax:310-540-0733
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77410207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A774100OtherBLUE SHIELD OF CA PIN
NV15760OtherMEDICAL LICENSE
CA00A774100Medicaid
CAA77410OtherBLUE CROSS PIN
AZ42383OtherMEDICAL LICENSE