Healthcare Provider Details

I. General information

NPI: 1780865352
Provider Name (Legal Business Name): BINA ADIGOPULA, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 03/27/2017
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 NumberFNP32339
License Number StateCA

VIII. Authorized Official

Name: DR. BINA ADIGOPULA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-698-2184