Provider Demographics
NPI:1164643953
Name:MUKKAMALA, APARNA (MD)
Entity Type:Individual
Prefix:
First Name:APARNA
Middle Name:
Last Name:MUKKAMALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:APARNA
Other - Middle Name:
Other - Last Name:VENIGALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:STE 900
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1844
Mailing Address - Country:US
Mailing Address - Phone:510-350-2600
Mailing Address - Fax:
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BLDG B, #220
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7464
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-324-4717
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96540207R00000X
TXM9518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199418801Medicaid
TX199418802Medicaid
TX199418804Medicaid
TX199418803Medicaid
CA00A965400Medicaid
TX315068YLP2Medicare PIN
TX199418801Medicaid
TX199418803Medicaid
TX8L3481Medicare PIN
CA00A965400Medicaid