Healthcare Provider Details

I. General information

NPI: 1023302734
Provider Name (Legal Business Name): SIRISHA NANDIPATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C112
LA JOLLA CA
92037-1703
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR STE C112
LA JOLLA CA
92037-1703
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-5871
  • 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: