Provider Demographics
NPI:1902865462
Name:KRISHNA, CHANDRIKA GOPALA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRIKA
Middle Name:GOPALA
Last Name:KRISHNA
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 1:254 SAN JOSE ST
Mailing Address - Street 2:STE A
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3900
Mailing Address - Country:US
Mailing Address - Phone:831-754-2222
Mailing Address - Fax:831-754-2278
Practice Address - Street 1:254 SAN JOSE ST
Practice Address - Street 2:STE A
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3900
Practice Address - Country:US
Practice Address - Phone:831-754-2222
Practice Address - Fax:831-754-2278
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA481250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481250Medicaid
CA00A481250Medicaid
CA00A481250Medicare ID - Type Unspecified