MEDICARE: MOUMITA SI PALLACHULLA

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	175T00000X	Peer Specialist		CA

General Provider Information

NPI Number	:	1588530018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUMITA SI PALLACHULLA

Provider Business Mailing Address
First Line	:	13024 VIA DEL VALEDOR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-3049
Country	:	US
Telephone Number	:	619-535-0348
Fax Number	:

Provider Business Practice Location Address
First Line	:	13024 VIA DEL VALEDOR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-3049
Country	:	US
Telephone Number	:	619-535-0348
Fax Number	:

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

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	10/13/2025

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Directions to “ MOUMITA SI PALLACHULLA ” Practice Location

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