Healthcare Provider Details

I. General information

NPI: 1104520634
Provider Name (Legal Business Name): MADHAVI MURALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DRIVE, MC 7895
LA JOLLA CA
92037
US

IV. Provider business mailing address

9300 CAMPUS POINT DRIVE, MC 7895
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-1967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: