Provider Demographics
NPI:1851533285
Name:MURALIDHARA, SOWMYA AMBUGA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOWMYA
Middle Name:AMBUGA
Last Name:MURALIDHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2249
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943
Mailing Address - Country:US
Mailing Address - Phone:619-461-1920
Mailing Address - Fax:619-461-1919
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-461-1920
Practice Address - Fax:619-461-1919
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine