MEDICARE: UNITED PSYCHIATRY, INC.

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	2084P0015X	Psychosomatic Medicine Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1245943596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PSYCHIATRY, INC.

Provider Business Mailing Address
First Line	:	1049 EL MONTE AVE STE C-755
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2398
Country	:	US
Telephone Number	:	650-441-8435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 EL MONTE AVE STE C755
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2398
Country	:	US
Telephone Number	:	650-600-0107
Fax Number	:

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	DR. PARVATHI NANJUNDIAH
Credential	:	MD
Telephone Number	:	650-441-8435

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	02/05/2024

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