Healthcare Provider Details

I. General information

NPI: 1144221953
Provider Name (Legal Business Name): PADMAVATHI KUDARAVALLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 MOWRY AVE STE 300
FREMONT CA
94538-1626
US

IV. Provider business mailing address

2333 MOWRY AVENUE SUITE 300
FREMONT CA
94538-1626
US

V. Phone/Fax

Practice location:
  • Phone: 510-284-4100
  • Fax: 510-794-9783
Mailing address:
  • Phone: 510-796-0222
  • Fax: 510-796-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA67964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: