Provider Demographics
NPI:1538121470
Name:PALADUGU, GEETHA KOMMINENI (MD)
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:KOMMINENI
Last Name:PALADUGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 TERRACINA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4870
Mailing Address - Country:US
Mailing Address - Phone:909-798-1763
Mailing Address - Fax:909-307-6405
Practice Address - Street 1:255 TERRACINA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-798-1763
Practice Address - Fax:909-307-6405
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA706922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H13419Medicare UPIN
CA00A706920Medicare UPIN