Healthcare Provider Details

I. General information

NPI: 1265764781
Provider Name (Legal Business Name): RAVI NALLAMOTHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAVI NATH NALLAMOTHU M.D.

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 WASHINGTON ST
CALISTOGA CA
94515-1433
US

IV. Provider business mailing address

6 WOODLAND RD SUITE 303
SAINT HELENA CA
94574-9501
US

V. Phone/Fax

Practice location:
  • Phone: 707-942-6233
  • Fax:
Mailing address:
  • Phone: 707-963-0267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC137072
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2015-01967
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC137072
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberM-16901
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM-16901
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: