Provider Demographics
NPI:1982686200
Name:ADIGOPULA, BINA (MD)
Entity Type:Individual
Prefix:DR
First Name:BINA
Middle Name:
Last Name:ADIGOPULA
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 1:6942 UNIVERSITY AVE
Mailing Address - Street 2:#A
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5963
Mailing Address - Country:US
Mailing Address - Phone:619-698-2184
Mailing Address - Fax:619-698-2084
Practice Address - Street 1:6942 UNIVERSITY AVE
Practice Address - Street 2:#A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5963
Practice Address - Country:US
Practice Address - Phone:619-698-2184
Practice Address - Fax:619-698-2084
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45273208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A45273OtherMEDICAL BOARD LICENCE
CA1982686200Medicaid