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General NPI Number Information
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NPI Number | 1679752075
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Entity Type | Organization
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Legal Business Name | B. V. CHANDRAMOULI, M..D., INC.
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 1555 EAST ST SUITE 100
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City | REDDING
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State | CA
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Zip | 96001-1153
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Country | US
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Telephone | 530-244-4471
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Fax | 530-244-1407
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Provider Business Mailing Address
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Address Line | 1555 EAST ST SUITE 100
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City | REDDING
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State | CA
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Zip | 96001-1153
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Country | US
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Telephone | 530-244-4471
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Fax | 530-244-1407
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Authorized Official
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Title or Position | PRESIDENT
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Name | B V CHANDRAMOULI
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Credential | M.D.
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Telephone | 530-244-4471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 00A521990
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 00A521990
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License Number State | CA
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