MEDICARE: MR. MUTHIYALIAH BABU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	A41533	CA

General Provider Information

NPI Number	:	1033141213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MUTHIYALIAH BABU M.D.

Provider Business Mailing Address
First Line	:	1401 E MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4801
Country	:	US
Telephone Number	:	805-349-0198
Fax Number	:	805-349-9004

Provider Business Practice Location Address
First Line	:	1401 E MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4801
Country	:	US
Telephone Number	:	805-349-0198
Fax Number	:	805-349-9004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/21/2014

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