Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | A104538 | CA |
NPI | 1073709416 |
---|---|
Provider Name | Dr. Arundathi Shenoy Malladi |
First Address | Larkspur, CA 94939 |
Second Address | Larkspur, CA 94939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 05/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8BE222 | BLUE CROSS (01) | TX |