Healthcare Provider Details

I. General information

NPI: 1386047660
Provider Name (Legal Business Name): RAKHESH GUTTIKONDA MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 EUCLID AVE STE 200
NATIONAL CITY CA
91950-2957
US

IV. Provider business mailing address

655 EUCLID AVE STE 200
NATIONAL CITY CA
91950-2957
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-4325
  • Fax:
Mailing address:
  • Phone: 619-470-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number20A13307
License Number StateCA

VIII. Authorized Official

Name: DR. RAKHESH GUTTIKONDA
Title or Position: PRESIDENT
Credential: DO
Phone: 619-437-1388