Healthcare Provider Details

I. General information

NPI: 1710902499
Provider Name (Legal Business Name): SAMATA KANAGALA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 SANTA RITA RD STE A
PLEASANTON CA
94566-5667
US

IV. Provider business mailing address

1393 SANTA RITA RD STE A
PLEASANTON CA
94566-5667
US

V. Phone/Fax

Practice location:
  • Phone: 925-317-6027
  • Fax: 925-481-3818
Mailing address:
  • Phone: 925-317-6027
  • Fax: 925-481-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA65024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: