Healthcare Provider Details

I. General information

NPI: 1861182180
Provider Name (Legal Business Name): MALHOTRA AND CHITTURI MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19661 S MOUNTAIN HOUSE PARKWAY
MOUNTAIN HOUSE CA
95391
US

IV. Provider business mailing address

19661 S MOUNTAIN HOUSE PARKWAY
MOUNTAIN HOUSE CA
95391
US

V. Phone/Fax

Practice location:
  • Phone: 209-685-1141
  • Fax:
Mailing address:
  • Phone: 209-685-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOUELLA REFE NADEAU
Title or Position: CREDENTIALING OFFICER
Credential: N/A
Phone: 209-685-1141