Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A118350 | CA |
NPI | 1275836959 |
---|---|
Provider Name | Krishna Ravi Cidambi |
First Address | San Diego, CA 92193-2410 |
Second Address | La Jolla, CA 92037-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2010 |
Last Update Date | 17/08/2017 |