Provider Demographics
NPI:1962599522
Name:PANGULURI, SANDHYA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDHYA
Middle Name:
Last Name:PANGULURI
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 1:13000 MOZART WAY
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1379
Mailing Address - Country:US
Mailing Address - Phone:562-402-0688
Mailing Address - Fax:
Practice Address - Street 1:17707 STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2640
Practice Address - Country:US
Practice Address - Phone:562-402-0688
Practice Address - Fax:562-809-0185
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA529882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A529880Medicaid
CAA52988OtherLICENSE
CAWA52988BOtherPPIN
MI4301056464OtherLICENSE
CABP3483613OtherDEA
CAF89508Medicare UPIN