Healthcare Provider Details

I. General information

NPI: 1639543572
Provider Name (Legal Business Name): RASHMI TUNUGUNTLA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 PACKARD AVE STE 500
MARYSVILLE CA
95901-7119
US

IV. Provider business mailing address

1114 YUBA ST STE 220
MARYSVILLE CA
95901-4838
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-3242
  • Fax: 530-767-1020
Mailing address:
  • Phone: 530-749-3242
  • Fax: 530-749-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number007595
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A15157
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: