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General NPI Number Information
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NPI Number | 1356665293
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Entity Type | Individual
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Provider Name | CHANDANA BOMMIREDDY M.D
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Gender | Female
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 648 CAYUGA DR
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City | SAN JOSE
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State | CA
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Zip | 95123-5507
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Country | US
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Telephone | 510-508-8103
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 CHURCHILL DOWNS CIR
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City | OAKDALE
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State | CA
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Zip | 95361-8682
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Country | US
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Telephone | 209-288-9520
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A128148
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License Number State | CA
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