Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 39219 | IA |
NPI | 1003070921 |
---|---|
Provider Name | Neetha Molakala |
First Address | Urbandale, IA 50322-5304 |
Second Address | Des Moines, IA 50314-2343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 16/01/2019 |