Provider Demographics
NPI:1790886174
Name:GUNTUPALLI, NAGESWARA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGESWARA
Middle Name:RAO
Last Name:GUNTUPALLI
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 1:500 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3762
Mailing Address - Country:US
Mailing Address - Phone:626-339-0288
Mailing Address - Fax:626-339-2248
Practice Address - Street 1:500 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3762
Practice Address - Country:US
Practice Address - Phone:626-339-0288
Practice Address - Fax:626-339-2248
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA549552084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549550Medicaid
CABP169ZMedicare PIN
CAF90779Medicare UPIN