Provider Demographics
NPI:1386740421
Name:THAYAPRAN, NALLATHAMBY (MD)
Entity type:Individual
Prefix:
First Name:NALLATHAMBY
Middle Name:
Last Name:THAYAPRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TAYA
Other - Middle Name:
Other - Last Name:THAYAPRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:240 N PORTER RD
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3140
Mailing Address - Country:US
Mailing Address - Phone:559-793-2677
Mailing Address - Fax:559-793-2650
Practice Address - Street 1:240 N PORTER RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3140
Practice Address - Country:US
Practice Address - Phone:559-793-2677
Practice Address - Fax:559-793-2650
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66422207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00460809OtherR R MEDICARE
CA00A664220Medicaid
G77564Medicare UPIN
CA00A664223Medicare PIN
CA00A664224Medicare PIN