Provider Demographics
NPI:1720430861
Name:MEENA SUBBARAO, MD INC.
Entity Type:Organization
Organization Name:MEENA SUBBARAO, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBBARAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-444-6263
Mailing Address - Street 1:335 KATHERINE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3176
Mailing Address - Country:US
Mailing Address - Phone:831-751-6222
Mailing Address - Fax:831-536-1828
Practice Address - Street 1:335 KATHERINE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3176
Practice Address - Country:US
Practice Address - Phone:831-444-6263
Practice Address - Fax:831-536-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56055208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033105432Medicaid