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General NPI Number Information
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NPI Number | 1275230690
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Entity Type | Individual
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Provider Name | RENUKA KUCHERLAPATI
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Gender | Female
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 230 RESERVATION RD
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City | MARINA
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State | CA
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Zip | 93933-3083
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Country | US
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Telephone | 831-900-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 478 TYLER ST
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City | MONTEREY
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State | CA
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Zip | 93940-3081
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 108599
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License Number State | CA
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