Provider Demographics
NPI:1174533319
Name:SERALATHAN, RAMASAMY (MD,)
Entity type:Individual
Prefix:DR
First Name:RAMASAMY
Middle Name:
Last Name:SERALATHAN
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W PUTNAM AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3269
Mailing Address - Country:US
Mailing Address - Phone:559-781-2000
Mailing Address - Fax:559-781-8679
Practice Address - Street 1:560 W PUTNAM AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3269
Practice Address - Country:US
Practice Address - Phone:559-781-2000
Practice Address - Fax:559-781-8679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43002208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C430020Medicaid
CA00C430020Medicare ID - Type Unspecified
CAD88696Medicare UPIN