Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | A152729 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | A152729 | CA |
NPI | 1265769806 |
---|---|
Provider Name | Guruprasad Tiptur Mahadevaiah |
First Address | Sacramento, CA 95816-5122 |
Second Address | Sacramento, CA 95816-5122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2009 |
Last Update Date | 31/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14901846 | (05) | NM |