Provider Demographics
NPI:1558399311
Name:BOYAPALLI, RENUKA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:R
Last Name:BOYAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3640 LOMITA BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3959
Mailing Address - Country:US
Mailing Address - Phone:310-373-0250
Mailing Address - Fax:310-373-0256
Practice Address - Street 1:3655 LOMITA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1902
Practice Address - Country:US
Practice Address - Phone:310-373-0250
Practice Address - Fax:310-373-0256
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056036207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A560360Medicaid
CAH12000Medicare UPIN
CAA056036Medicare ID - Type Unspecified