Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 13307 | CA |
NPI | 1073889465 |
---|---|
Provider Name | Rakhesh Guttikonda |
First Address | Coronado, CA 92118 |
Second Address | Coronado, CA 92118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 18/06/2014 |