Healthcare Provider Details

I. General information

NPI: 1013397652
Provider Name (Legal Business Name): MANJULA MUPPU MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 MONTIANO CT
DUBLIN CA
94568-2917
US

IV. Provider business mailing address

5280 MONTIANO CT
DUBLIN CA
94568-2917
US

V. Phone/Fax

Practice location:
  • Phone: 925-998-4151
  • Fax:
Mailing address:
  • Phone: 925-998-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA115266
License Number StateCA

VIII. Authorized Official

Name: MANJULA MUPPU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-998-4151