Provider Demographics
NPI:1780865352
Name:BINA ADIGOPULA, MD, INC.
Entity Type:Organization
Organization Name:BINA ADIGOPULA, MD, INC.
Other - Org Name:GROSSMONT PEDIATRICS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIGOPULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-698-2184
Mailing Address - Street 1:6942 UNIVERSITY AVE
Mailing Address - Street 2:A
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5963
Mailing Address - Country:US
Mailing Address - Phone:619-698-2184
Mailing Address - Fax:619-698-2084
Practice Address - Street 1:6942 UNIVERSITY AVE
Practice Address - Street 2:A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5963
Practice Address - Country:US
Practice Address - Phone:619-698-2184
Practice Address - Fax:619-698-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP32339208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780865352Medicaid
CA32339OtherFNP