Provider Demographics
NPI:1104118439
Name:CHARUGUNDLA, PRATHIMA SMRUTHI (DO)
Entity type:Individual
Prefix:DR
First Name:PRATHIMA
Middle Name:SMRUTHI
Last Name:CHARUGUNDLA
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18460 ROSCOE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4107
Practice Address - Country:US
Practice Address - Phone:548-081-8885
Practice Address - Fax:818-993-1917
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A12826208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12826OtherLICENSE