Provider Demographics
NPI:1821596974
Name:NAYAK, PADMA GANESH
Entity Type:Individual
Prefix:
First Name:PADMA
Middle Name:GANESH
Last Name:NAYAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 N LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9661
Mailing Address - Country:US
Mailing Address - Phone:559-827-4894
Mailing Address - Fax:
Practice Address - Street 1:171 N LINDSAY ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-9661
Practice Address - Country:US
Practice Address - Phone:559-827-4894
Practice Address - Fax:559-827-4894
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty