Healthcare Provider Details

I. General information

NPI: 1104016054
Provider Name (Legal Business Name): VEENA RANI MAMIDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S ELM AVE
FRESNO CA
93706-5435
US

IV. Provider business mailing address

1945 N FINE AVE STE 116
FRESNO CA
93727-1528
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5200
  • Fax: 559-457-5290
Mailing address:
  • Phone: 559-457-5800
  • Fax: 559-457-5894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA121658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: