Healthcare Provider Details

I. General information

NPI: 1134652563
Provider Name (Legal Business Name): ANOOP NAGA MUNIYAPPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 MEDICAL CENTER DR # MC7411
LA JOLLA CA
92037-1337
US

IV. Provider business mailing address

505 PARNASSUS AVE RM M-987
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8530
  • Fax: 858-657-8814
Mailing address:
  • Phone: 858-735-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA160537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: