Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A109056 | CA |
Y | 2080P0210X | Pediatric Nephrologist | A109056 | CA |
NPI | 1932304342 |
---|---|
Provider Name | Sujana S Gunta |
First Address | Vista, CA 92084-5218 |
Second Address | Vista, CA 92084-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 27/02/2014 |