Healthcare Provider Details

I. General information

NPI: 1013830165
Provider Name (Legal Business Name): HEMALATHA GUJJARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SAIL VIEW AVE
RANCHO PALOS VERDES CA
90275-5705
US

IV. Provider business mailing address

22 SAIL VIEW AVE
RANCHO PALOS VERDES CA
90275-5705
US

V. Phone/Fax

Practice location:
  • Phone: 510-456-5684
  • Fax:
Mailing address:
  • Phone: 510-456-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-35461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: