Provider Demographics
NPI:1699868133
Name:GNANADESIKAN, MUKUND (MD)
Entity type:Individual
Prefix:DR
First Name:MUKUND
Middle Name:
Last Name:GNANADESIKAN
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 1:2751 NAPA VALLEY CORPORATE DR.
Mailing Address - Street 2:BLDGS A & B
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-6216
Mailing Address - Country:US
Mailing Address - Phone:707-259-8167
Mailing Address - Fax:707-259-8651
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-259-8167
Practice Address - Fax:707-259-8651
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ280842084P0804X
CAC530632084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry