Provider Demographics
NPI:1760740039
Name:MITTAKANTI, HARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:HARSHA
Middle Name:
Last Name:MITTAKANTI
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 1:23845 HOLMAN HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5901
Mailing Address - Country:US
Mailing Address - Phone:831-241-9155
Mailing Address - Fax:831-886-3616
Practice Address - Street 1:23845 HOLMAN HWY STE 203
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5901
Practice Address - Country:US
Practice Address - Phone:831-241-9155
Practice Address - Fax:831-886-3616
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126779208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology