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General NPI Number Information
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NPI Number | 1821139684
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Entity Type | Individual
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Provider Name | PRAKRUTI REDDY JAMBULA MD
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 3333 BURNET AVE
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 3827 BROOKMERE PL
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City | MASON
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State | OH
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Zip | 45040-3029
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Country | US
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Telephone | 513-435-3989
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.091930
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 35.091930
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License Number State | OH
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