Healthcare Provider Details

I. General information

NPI: 1629021662
Provider Name (Legal Business Name): NEELIMA KETHINENI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TELEGRAPH AVE RM 2000
OAKLAND CA
94609-3239
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8290
  • Fax:
Mailing address:
  • Phone: 510-204-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA90570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: