Provider Demographics
NPI:1366973604
Name:MOLEYAR NARAYANA, PRASEEDA (MD)
Entity type:Individual
Prefix:
First Name:PRASEEDA
Middle Name:
Last Name:MOLEYAR NARAYANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:245 MOUNT HERMON RD STE L
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4044
Practice Address - Country:US
Practice Address - Phone:831-430-7203
Practice Address - Fax:831-430-7204
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA170454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine