Provider Demographics
NPI:1518642230
Name:KALLURI, SUCHETHA PARVATI
Entity Type:Individual
Prefix:
First Name:SUCHETHA
Middle Name:PARVATI
Last Name:KALLURI
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 1:66 S SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1720
Mailing Address - Country:US
Mailing Address - Phone:805-947-5175
Mailing Address - Fax:
Practice Address - Street 1:66 S SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1720
Practice Address - Country:US
Practice Address - Phone:805-947-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker