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General NPI Number Information
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NPI Number | 1750541363
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Entity Type | Organization
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Legal Business Name | PULIADI JOTHIKUMAR,M.D.INC
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1110 DELBON AVE
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City | TURLOCK
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State | CA
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Zip | 95382-2021
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Country | US
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Telephone | 209-632-9345
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 DELBON AVE
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City | TURLOCK
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State | CA
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Zip | 95382-2021
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Country | US
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Telephone | 209-632-9345
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PULIADI JOTHIKUMAR
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Credential | M.D.,
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Telephone | 209-632-9345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A30333
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License Number State | CA
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