Provider Demographics
NPI:1033141213
Name:BABU, MUTHIYALIAH (MD)
Entity Type:Individual
Prefix:MR
First Name:MUTHIYALIAH
Middle Name:
Last Name:BABU
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 1:1401 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4801
Mailing Address - Country:US
Mailing Address - Phone:805-349-0198
Mailing Address - Fax:805-349-9004
Practice Address - Street 1:1401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4801
Practice Address - Country:US
Practice Address - Phone:805-349-0198
Practice Address - Fax:805-349-9004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41533207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29400Medicare UPIN