Provider Demographics
NPI:1710515903
Name:AKSHAY BOMMIREDDI
Entity Type:Organization
Organization Name:AKSHAY BOMMIREDDI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IM RESIDENCY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-851-3817
Mailing Address - Street 1:710 LAWRENCE EXPY FL 3
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 LAWRENCE EXPY FL 3
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-3817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty