Provider Demographics
NPI:1134164569
Name:CHETLAPALLI, SURYA RADHIKA (MD)
Entity type:Individual
Prefix:DR
First Name:SURYA
Middle Name:RADHIKA
Last Name:CHETLAPALLI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11018 W OCEAN AIR DR APT 264
Mailing Address - Street 2:APT 264
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4624
Mailing Address - Country:US
Mailing Address - Phone:858-259-8387
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:STE 900
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-626-7782
Practice Address - Fax:858-626-4604
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAA96196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA96196OtherCALIFORNIA MEDICALLICENSE
BC9951484OtherDEA