Provider Demographics
NPI:1710120118
Name:GOLLAPALLE, MYTHRI REDDY
Entity Type:Individual
Prefix:DR
First Name:MYTHRI
Middle Name:REDDY
Last Name:GOLLAPALLE
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 1:39500 LIBERTY ST
Mailing Address - Street 2:TRI-CITY HEALTH CENTER
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2211
Mailing Address - Country:US
Mailing Address - Phone:510-770-8040
Mailing Address - Fax:
Practice Address - Street 1:39500 LIBERTY ST
Practice Address - Street 2:TRI-CITY HEALTH CENTER
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2211
Practice Address - Country:US
Practice Address - Phone:510-770-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine