Healthcare Provider Details

I. General information

NPI: 1528054640
Provider Name (Legal Business Name): PADMA NANDURI M.D., F.A.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

5330 CARROLL CANYON RD SUITE 210
SAN DIEGO CA
92121-3756
US

IV. Provider business mailing address

5330 CARROLL CANYON RD SUITE 210
SAN DIEGO CA
92121-3756
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-1010
  • Fax: 858-450-9451
Mailing address:
  • Phone: 858-450-1010
  • Fax: 858-450-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA73131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: