Provider Demographics
NPI:1992761118
Name:GUBBALA, SUNITHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNITHA
Middle Name:
Last Name:GUBBALA
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 1:2410 SAMARITAN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3909
Mailing Address - Country:US
Mailing Address - Phone:408-371-9010
Mailing Address - Fax:408-371-2633
Practice Address - Street 1:2410 SAMARITAN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3909
Practice Address - Country:US
Practice Address - Phone:408-371-9010
Practice Address - Fax:408-371-2633
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A791200OtherRAILROAD MEDICARE
CA00A791200OtherMEDICARE ID-TYPE UNSPECIFIED
CAH80100Medicare UPIN
CA00A791200OtherMEDICARE ID-TYPE UNSPECIFIED