Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A102181 | CA |
N | 111NI0900X | Internist | A102181 | CA |
NPI | 1003008590 |
---|---|
Provider Name | Radha Chirumamilla |
First Address | Modesto, CA 95355-4201 |
Second Address | Modesto, CA 95355-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 25/03/2011 |