Provider Demographics
NPI:1518086404
Name:TATA, SATYA VISALAKSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SATYA
Middle Name:VISALAKSHI
Last Name:TATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SATYA
Other - Middle Name:VISALAKSHI
Other - Last Name:AKELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10531 4S COMMONS DR STE 166566
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3517
Mailing Address - Country:US
Mailing Address - Phone:588-876-3150
Mailing Address - Fax:866-764-5413
Practice Address - Street 1:15373 INNOVATION DR STE 395
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3429
Practice Address - Country:US
Practice Address - Phone:588-876-3150
Practice Address - Fax:866-764-5413
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA982732084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI74014Medicare UPIN
CAWA98273AMedicare PIN
CAW416Medicare PIN