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General NPI Number Information
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NPI Number | 1225119464
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Entity Type | Individual
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Provider Name | HANUMANTHARAO DAMERLA M.D.,
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 1900 SYCAMORE CANYON RD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1220
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Country | US
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Telephone | 626-975-2968
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Fax | 213-639-1361
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Provider Business Mailing Address
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Address Line | 550 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90020-1912
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Country | US
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Telephone | 213-738-2902
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Fax | 213-639-1361
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A69165
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License Number State | CA
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