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General NPI Number Information
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NPI Number | 1356143416
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Entity Type | Organization
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Legal Business Name | SHARATH RENIGUNTALA MD INC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 431 N TUSTIN AVE STE B
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City | SANTA ANA
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State | CA
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Zip | 92705-3821
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Country | US
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Telephone | 949-272-9919
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SOURCE
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City | IRVINE
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State | CA
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Zip | 92618-1370
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Country | US
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Telephone | 312-550-1409
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHARATH RENIGUNTALA
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Credential | MD
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Telephone | 312-550-1409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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