Healthcare Provider Details

I. General information

NPI: 1982686200
Provider Name (Legal Business Name): BINA ADIGOPULA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6942 UNIVERSITY AVE #A
LA MESA CA
91942-5963
US

IV. Provider business mailing address

6942 UNIVERSITY AVE #A
LA MESA CA
91942-5963
US

V. Phone/Fax

Practice location:
  • Phone: 619-698-2184
  • Fax: 619-698-2084
Mailing address:
  • Phone: 619-698-2184
  • Fax: 619-698-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA45273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: