Provider Demographics
NPI:1851304786
Name:KUNAMNENI, HYMAVATHI DEVI (PHD)
Entity Type:Individual
Prefix:MRS
First Name:HYMAVATHI
Middle Name:DEVI
Last Name:KUNAMNENI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N CALIFORNIA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6032
Mailing Address - Country:US
Mailing Address - Phone:209-469-3690
Mailing Address - Fax:209-467-1502
Practice Address - Street 1:1805 N CALIFORNIA ST STE 202
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6032
Practice Address - Country:US
Practice Address - Phone:209-469-3690
Practice Address - Fax:209-467-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17013103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-05-688OtherACCESS MANAGED CARE
CAOPL170130OtherBLUE SHIELD
CAPSY170130Medicaid
CA447320OtherVALUE OPTIONS
CAP00089953OtherPALMETTO GBA
CAP00089953OtherPALMETTO GBA