Individual
DR. ETTAYAPURUM V SUNDERRAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11180 WARNER AVE, SUITE 253, FOUNTAIN VALLEY, CA 92708-7501
(714) 979-2825
(714) 979-2862
Mailing address
11180 WARNER AVE, SUITE 253, FOUNTAIN VALLEY, CA 92708-7501
(714) 979-2825
(714) 979-2862
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
A42385
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330387285
BLUE CROSS OF CALIFORNIA
CA
01
—
330387825
AETNA
CA
01
—
GR0053330
CAL-OPTIMA
CA
01
—
ZZZ33736Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
06/03/2006
Last updated
04/24/2013
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