Healthcare Provider Details

I. General information

NPI: 1932124757
Provider Name (Legal Business Name): JOTHIKA N MANEPALLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/26/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

7100 ALVERN ST APT 410
LOS ANGELES CA
90045-3817
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9059
  • Fax:
Mailing address:
  • Phone: 314-452-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR5J48
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR5J48
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: