Organization
NEWBORN SPECIAL CARE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUMITHRA KOMMAREDDY (PRINCIPAL OFFICER/DIRECTOR/OWNER)
(949) 492-3514
Entity
Organization
Contact information
Practice address
1720 E CESAR E CHAVEZ AVE, LOS ANGELES, CA 90033-2414
(323) 268-5000
Mailing address
PO BOX 1359, SAN CLEMENTE, CA 92674-1359
(949) 492-3514
(949) 366-2390
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1761090
SECRETARY OF STATE
CA
Enumeration date
02/25/2009
Last updated
02/25/2009
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