Provider Demographics
NPI:1649324385
Name:MUDIVARTHI, ARCHANA PRASANTI (MD)
Entity type:Individual
Prefix:MRS
First Name:ARCHANA
Middle Name:PRASANTI
Last Name:MUDIVARTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ARCHANA
Other - Middle Name:PRASANTI
Other - Last Name:MUDIVARTHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:320 CALDECOTT LN UNIT 212
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2427
Mailing Address - Country:US
Mailing Address - Phone:650-619-0600
Mailing Address - Fax:
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-2696
Practice Address - Fax:510-307-1985
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA936582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology