Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 36696 | CA |
NPI | 1194279323 |
---|---|
Provider Name | Mrs. Deepti D Nagalla |
First Address | Pleasanton, CA 94588-2625 |
Second Address | Pleasanton, CA 94588-2625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2016 |
Last Update Date | 04/08/2016 |