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General NPI Number Information
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NPI Number | 1568807436
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Entity Type | Organization
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Legal Business Name | SIVA PRASAD MULLANGI MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 5365 WALNUT AVE STE I
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-315-6399
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Fax | 909-315-6696
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Provider Business Mailing Address
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Address Line | PO BOX 898
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City | CHINO HILLS
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State | CA
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Zip | 91709-0030
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Country | US
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Telephone | 909-912-4353
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Fax | 909-626-8384
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Authorized Official
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Title or Position | PRESIDENT
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Name | SIVA P MULLANGI
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Credential | MD
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Telephone | 909-912-4353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A64112
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License Number State | CA
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