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General NPI Number Information
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NPI Number | 1629506605
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Entity Type | Individual
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Provider Name | SAMYUKTHA BALABHADRA MD
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Gender | Female
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 250 CHERRY LN STE 116
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City | MANTECA
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State | CA
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Zip | 95337-4398
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Country | US
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Telephone | 209-647-2184
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Fax |
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Provider Business Mailing Address
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Address Line | 250 CHERRY LN STE 116
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City | MANTECA
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State | CA
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Zip | 95337-4398
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Country | US
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Telephone | 209-647-2184
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A177637
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License Number State | CA
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