Provider Demographics
NPI:1497909287
Name:SANGEETHA MURTHY INCORPORATED
Entity Type:Organization
Organization Name:SANGEETHA MURTHY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGEETHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-874-8741
Mailing Address - Street 1:16121 DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1828
Mailing Address - Country:US
Mailing Address - Phone:858-874-8741
Mailing Address - Fax:888-420-4642
Practice Address - Street 1:7830 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE 287
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1619
Practice Address - Country:US
Practice Address - Phone:858-874-8741
Practice Address - Fax:888-420-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A849500Medicaid
CAA84950OtherLICENSE
CA00A849500Medicaid
CAA84950Medicare PIN