MEDICARE: INDULATHA ARAMANDLA 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	2084P0800X	Psychiatry Physician	TP623	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TP623	OTHER	KY	LICENSE #

General Provider Information

NPI Number	:	1295831014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDULATHA ARAMANDLA M.D.

Provider Business Mailing Address
First Line	:	3100 OAK RD STE 270
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2078
Country	:	US
Telephone Number	:	925-944-9711
Fax Number	:	925-944-9709

Provider Business Practice Location Address
First Line	:	3100 OAK RD STE 270
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2078
Country	:	US
Telephone Number	:	925-944-9711
Fax Number	:	925-944-9709

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	08/31/2020

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