Provider Demographics
NPI:1073889895
Name:NAYAK, RENUKA RAJENDRA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:RAJENDRA
Last Name:NAYAK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2915
Mailing Address - Country:US
Mailing Address - Phone:215-840-6214
Mailing Address - Fax:
Practice Address - Street 1:513 PARNASSUS AVE
Practice Address - Street 2:S847 BOX 0500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2205
Practice Address - Country:US
Practice Address - Phone:215-840-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine