Provider Demographics
NPI:1104322239
Name:KURUVADI, NISHA
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:KURUVADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 EUCLID AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2950
Mailing Address - Country:US
Mailing Address - Phone:903-232-8290
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:4221 COLLING RD W
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2557
Practice Address - Country:US
Practice Address - Phone:619-421-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018606207R00000X
TXS9922207R00000X
CA20100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine