Provider Demographics
NPI:1538140819
Name:NITHYANANDA, MUNI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNI
Middle Name:
Last Name:NITHYANANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:A
Other - Last Name:VERSTEEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:769 PANORAMA PL
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1020
Mailing Address - Country:US
Mailing Address - Phone:626-795-0350
Mailing Address - Fax:626-795-3531
Practice Address - Street 1:769 PANORAMA PL
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1020
Practice Address - Country:US
Practice Address - Phone:626-795-0350
Practice Address - Fax:626-795-3531
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42221208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C422231Medicaid
CA00C422231Medicaid
CAC42223Medicare ID - Type Unspecified