MEDICARE: NAMITHA NAGABHUSHANA MALAKKLA MD

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	208M00000X	Hospitalist Physician	35.145351	OH
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35.145351	OH
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A177847	CA
4	207R00000X	Internal Medicine Physician	35.145351	OH
5	207R00000X	Internal Medicine Physician	A177847	CA

General Provider Information

NPI Number	:	1700348125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAMITHA NAGABHUSHANA MALAKKLA MD

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:	916-854-6769

Provider Business Practice Location Address
First Line	:	1651 EXPOSITION BLVD STE 304
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-5149
Country	:	US
Telephone Number	:	916-455-3700
Fax Number	:	916-503-7568

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	12/18/2025

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