Provider Demographics
NPI:1720026271
Name:GUNDA, NARAYANA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:NARAYANA
Middle Name:RAO
Last Name:GUNDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2104
Mailing Address - Country:US
Mailing Address - Phone:305-356-2343
Mailing Address - Fax:
Practice Address - Street 1:912 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2143
Practice Address - Country:US
Practice Address - Phone:530-926-3653
Practice Address - Fax:530-926-1359
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0832207R00000X
CAA70434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH46259Medicare UPIN