Provider Demographics
NPI:1720032972
Name:KURELLA, MANJULA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MANJULA
Middle Name:
Last Name:KURELLA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MANJULA
Other - Middle Name:
Other - Last Name:TAMURA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3333 CALIFORNIA ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1211
Mailing Address - Country:US
Mailing Address - Phone:415-476-2173
Mailing Address - Fax:415-476-8247
Practice Address - Street 1:1701 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3011
Practice Address - Country:US
Practice Address - Phone:415-476-2173
Practice Address - Fax:415-476-3381
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79151207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A791510Medicaid
CA00A791510Medicaid
CAH76448Medicare UPIN