Healthcare Provider Details

I. General information

NPI: 1972809978
Provider Name (Legal Business Name): ANDHAVARAPU & CABALUNA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 W LACEY BLVD
HANFORD CA
93230-5965
US

IV. Provider business mailing address

296 W HAROLD GRISWOLD WAY
HANFORD CA
93230-8310
US

V. Phone/Fax

Practice location:
  • Phone: 559-583-4505
  • Fax:
Mailing address:
  • Phone: 559-381-9051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA102374
License Number StateCA

VIII. Authorized Official

Name: DR. GIRIDHAR ANDHAVARAPU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-583-4505