MEDICARE: KOTESWARA RAO NALAMOLU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	INT47922	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y7311243	OTHER	CA	CALIFORNIA DEPARTMENT OF MOTOR VEHICLES

General Provider Information

NPI Number	:	1598330516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOTESWARA RAO NALAMOLU

Provider Business Mailing Address
First Line	:	262 N PIERCE AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-0175
Country	:	US
Telephone Number	:	309-216-4381
Fax Number	:

Provider Business Practice Location Address
First Line	:	7072 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3300
Country	:	US
Telephone Number	:	919-986-0153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/21/2021

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Directions to “ KOTESWARA RAO NALAMOLU ” Practice Location

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