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Organization
USC PPA, INC.
Active
Organization
USC PPA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SURESH BANGARA M.D. (C.E.O.)
(323) 442-6000
Entity
Organization
Contact information
Practice address
1520 SAN PABLO ST, STE 4100, LOS ANGELES, CA 90033-5316
(323) 442-6000
(323) 442-6001
Mailing address
1520 SAN PABLO ST, STE 4100, LOS ANGELES, CA 90033-5316
(323) 442-6000
(323) 442-6001
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY5097
CA
Other
Enumeration date
05/24/2005
Last updated
08/22/2020
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