Provider Demographics
NPI:1407161961
Name:NONIS, PRADEEPA SUBASHEENI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEPA
Middle Name:SUBASHEENI
Last Name:NONIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRADEEPA
Other - Middle Name:SUBASHEENI
Other - Last Name:IDDAMALGODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1750 PRAIRIE CITY RD
Mailing Address - Street 2:STE 130 PMB 148
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-9595
Mailing Address - Country:US
Mailing Address - Phone:310-938-9507
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVENUE
Practice Address - Street 2:KAISER PERMANENTE SACRAMENTO MEDICAL CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:310-938-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center