Healthcare Provider Details

I. General information

NPI: 1720430861
Provider Name (Legal Business Name): MEENA SUBBARAO, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 KATHERINE AVE SUITE 1
SALINAS CA
93901-3176
US

IV. Provider business mailing address

335 KATHERINE AVE STE 1
SALINAS CA
93901-3176
US

V. Phone/Fax

Practice location:
  • Phone: 831-444-6263
  • Fax: 831-536-1828
Mailing address:
  • Phone: 831-751-6222
  • Fax: 831-536-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA56055
License Number StateCA

VIII. Authorized Official

Name: MEENA SUBBARAO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 831-444-6263