Provider Demographics
NPI:1710093349
Name:MANJAPPA, NAGARATHNA G (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGARATHNA
Middle Name:G
Last Name:MANJAPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 BEARD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3673
Mailing Address - Country:US
Mailing Address - Phone:707-253-7005
Mailing Address - Fax:
Practice Address - Street 1:3230 BEARD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3673
Practice Address - Country:US
Practice Address - Phone:707-253-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118723207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA181135Medicare PIN
CACA164070Medicare PIN