Organization
BASIC ON-CALL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GOWRIHARAN THAIYANANTHAN M.D. (PRESIDENT)
(949) 282-1881
Entity
Organization
Contact information
Practice address
4631 TELLER AVE, SUITE 100, NEWPORT BEACH, CA 92660-8105
(949) 292-1881
Mailing address
6100 CENTER DR, SUITE 600, LOS ANGELES, CA 90045-9200
(949) 292-1881
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
A80845
CA
207T00000X
Neurological Surgery Physician
Primary
A99924
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518164110
1518164110
CA
01
—
1639355472
1639355472
CA
Enumeration date
02/05/2013
Last updated
02/05/2013
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