Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A151331 | CA |
NPI | 1003107152 |
---|---|
Provider Name | Dr. Sharath Kumar Elias Reniguntala |
First Address | Anaheim, CA 92801-6730 |
Second Address | Anaheim, CA 92801-6730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 27/01/2020 |