Provider Demographics
NPI:1902019433
Name:PALAGUMMI, SAMBRAJYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMBRAJYA
Middle Name:
Last Name:PALAGUMMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23500 KASSON ROAD
Mailing Address - Street 2:PO BOX 400
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-0400
Mailing Address - Country:US
Mailing Address - Phone:209-835-4141
Mailing Address - Fax:
Practice Address - Street 1:23500 KASSON ROAD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95378-0400
Practice Address - Country:US
Practice Address - Phone:209-835-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice