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General NPI Number Information
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NPI Number | 1205056470
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Entity Type | Individual
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Provider Name | MADHAVI SUDHAKAR MULYE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1132 S BRISTOL ST
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City | SANTA ANA
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State | CA
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Zip | 92704-3420
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Country | US
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Telephone | 714-424-0800
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Fax | 714-424-0128
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Provider Business Mailing Address
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Address Line | 1201 WALNUT AVE APARTMENT # 70
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City | TUSTIN
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State | CA
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Zip | 92780-5772
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Country | US
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Telephone | 714-368-9161
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A66772
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License Number State | CA
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