Healthcare Provider Details

I. General information

NPI: 1558642975
Provider Name (Legal Business Name): RAVIKUMAR HANUMAIAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13280 EVENING CREEK DR S STE 110
SAN DIEGO CA
92128-4109
US

IV. Provider business mailing address

13280 EVENING CREEK DR S STE 110
SAN DIEGO CA
92128-4109
US

V. Phone/Fax

Practice location:
  • Phone: 858-546-3800
  • Fax:
Mailing address:
  • Phone: 858-546-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberV9328
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberV9328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: