Provider Demographics
NPI:1720320989
Name:PUCHAKAYALA, NANDITA (MD)
Entity Type:Individual
Prefix:
First Name:NANDITA
Middle Name:
Last Name:PUCHAKAYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANDITA
Other - Middle Name:
Other - Last Name:KUNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1809 W REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8054
Mailing Address - Country:US
Mailing Address - Phone:909-335-3026
Mailing Address - Fax:909-335-3167
Practice Address - Street 1:12555 CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3569
Practice Address - Country:US
Practice Address - Phone:909-902-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1387162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry