Provider Demographics
NPI:1699126771
Name:GUNDRATHI, JALAJA (MD)
Entity type:Individual
Prefix:DR
First Name:JALAJA
Middle Name:
Last Name:GUNDRATHI
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 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-5437
Mailing Address - Fax:641-428-5437
Practice Address - Street 1:910 N EISENHOWER
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1525
Practice Address - Country:US
Practice Address - Phone:641-428-5437
Practice Address - Fax:641-428-5800
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC2000X
IAMD-45745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No282NC2000XHospitalsGeneral Acute Care HospitalChildren