Provider Demographics
NPI:1003432774
Name:VENKATASHAMAPPA, NEELAMMA
Entity type:Individual
Prefix:DR
First Name:NEELAMMA
Middle Name:
Last Name:VENKATASHAMAPPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 SUMMERDALE RD APT 29
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5430
Mailing Address - Country:US
Mailing Address - Phone:669-264-7772
Mailing Address - Fax:
Practice Address - Street 1:5451 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2609
Practice Address - Country:US
Practice Address - Phone:909-464-8623
Practice Address - Fax:909-464-8616
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program