Provider Demographics
NPI:1528050960
Name:NYAMATHI, ESWAR APPA (MD)
Entity type:Individual
Prefix:
First Name:ESWAR
Middle Name:APPA
Last Name:NYAMATHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17075 DEVONSHIRE ST
Mailing Address - Street 2:STE 106
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1600
Mailing Address - Country:US
Mailing Address - Phone:818-831-3287
Mailing Address - Fax:818-831-3267
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:STE 106
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-831-3287
Practice Address - Fax:818-831-3267
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA409192086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A409190Medicaid
A88547Medicare UPIN
CAA40919Medicare PIN