Provider Demographics
NPI:1255599270
Name:MANJUNATH, VEENA (MD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:MANJUNATH
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 1:2905 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2017
Mailing Address - Country:US
Mailing Address - Phone:510-841-0411
Mailing Address - Fax:510-204-9086
Practice Address - Street 1:2905 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2017
Practice Address - Country:US
Practice Address - Phone:510-841-0411
Practice Address - Fax:510-204-9086
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116837207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology