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General NPI Number Information
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NPI Number | 1649508318
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Entity Type | Individual
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Provider Name | DEEPA KANNADITHARAYIL MBBS
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Gender | Female
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 600 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-4201
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Country | US
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Telephone | 209-550-4785
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Fax | 209-550-4888
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Provider Business Mailing Address
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Address Line | 10470 OLD PLACERVILLE RD STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95827-2539
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Country | US
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Telephone | 800-470-0071
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A143758
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License Number State | CA
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