Provider Demographics
NPI:1225119464
Name:DAMERLA, HANUMANTHARAO (MD,)
Entity Type:Individual
Prefix:DR
First Name:HANUMANTHARAO
Middle Name:
Last Name:DAMERLA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:HANUMANTHARAO
Other - Middle Name:SP
Other - Last Name:DAMERLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:550 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1912
Mailing Address - Country:US
Mailing Address - Phone:213-738-2902
Mailing Address - Fax:213-639-1361
Practice Address - Street 1:1900 SYCAMORE CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1220
Practice Address - Country:US
Practice Address - Phone:626-975-2968
Practice Address - Fax:213-639-1361
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA691652084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry