Provider Demographics
NPI:1881883734
Name:UTHAIAH KOKKALERA MD, INC.
Entity type:Organization
Organization Name:UTHAIAH KOKKALERA MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALNACHEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-700-7900
Mailing Address - Street 1:PO BOX 33276
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91394-3276
Mailing Address - Country:US
Mailing Address - Phone:818-700-7900
Mailing Address - Fax:
Practice Address - Street 1:18250 ROSCOE BLVD.
Practice Address - Street 2:# 335
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4282
Practice Address - Country:US
Practice Address - Phone:818-700-7900
Practice Address - Fax:818-700-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty