Healthcare Provider Details

I. General information

NPI: 1275836959
Provider Name (Legal Business Name): KRISHNA RAVI CIDAMBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 FROST ST STE 106
SAN DIEGO CA
92123-4229
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-5434
  • Fax: 858-939-5471
Mailing address:
  • Phone: 858-249-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA118350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: