Provider Demographics
NPI:1386815090
Name:SIDDABASAPPA, ROOPA KYATHANAHALLY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOPA
Middle Name:KYATHANAHALLY
Last Name:SIDDABASAPPA
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 1:6620 VIA DEL ORO
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1392
Mailing Address - Country:US
Mailing Address - Phone:408-360-2300
Mailing Address - Fax:
Practice Address - Street 1:175 BERNAL RD
Practice Address - Street 2:1ST FLOOR - SUITE 140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1343
Practice Address - Country:US
Practice Address - Phone:408-972-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1016442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry