Healthcare Provider Details

I. General information

NPI: 1265992630
Provider Name (Legal Business Name): NAVEETHA NANDAKUMAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE STE 325
PASADENA CA
91105-2675
US

IV. Provider business mailing address

625 S FAIR OAKS AVE STE 325
PASADENA CA
91105-2675
US

V. Phone/Fax

Practice location:
  • Phone: 626-535-9344
  • Fax:
Mailing address:
  • Phone: 626-535-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A20859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: