Provider Demographics
NPI:1407349913
Name:PUSSADHAMMA, NDAYAPA
Entity Type:Individual
Prefix:
First Name:NDAYAPA
Middle Name:
Last Name:PUSSADHAMMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13079 FRANCISQUITO AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3704
Mailing Address - Country:US
Mailing Address - Phone:626-549-9675
Mailing Address - Fax:
Practice Address - Street 1:1253 VINE ST STE 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-1662
Practice Address - Country:US
Practice Address - Phone:323-747-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist