Provider Demographics
NPI:1023463916
Name:MAMIDANNA, POOJA RATNASREE
Entity type:Individual
Prefix:MS
First Name:POOJA
Middle Name:RATNASREE
Last Name:MAMIDANNA
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 1:170 KING ST UNIT 802
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-4912
Mailing Address - Country:US
Mailing Address - Phone:408-620-0516
Mailing Address - Fax:408-954-8399
Practice Address - Street 1:170 KING ST UNIT 802
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-4912
Practice Address - Country:US
Practice Address - Phone:408-620-0516
Practice Address - Fax:408-954-8399
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program