Individual
SUVEPA LERTWONGKANAKOOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1234 GRANVILLE AVENUE, #1, LOS ANGELES, CA 90025-1685
(310) 231-4391
(310) 231-4390
Mailing address
1234 GRANVILLE AVENUE, #1, LOS ANGELES, CA 90025-1685
(310) 231-4391
(310) 231-4390
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E3715
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E37150
—
CA
01
—
480016471
RAILROAD MEDICARE
CA
Enumeration date
11/30/2006
Last updated
01/08/2015
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