Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A51292 | CA |
NPI | 1003802612 |
---|---|
Provider Name | Manjula Kamaraju |
First Address | San Jose, CA 95124-3907 |
Second Address | San Jose, CA 95124-3907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F74722 | (02) |