Provider Demographics
NPI:1912103318
Name:GUMMADAPU, RAGINI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGINI
Middle Name:
Last Name:GUMMADAPU
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 1:12708 CORLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAMIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1925
Mailing Address - Country:US
Mailing Address - Phone:562-777-2575
Mailing Address - Fax:562-777-2575
Practice Address - Street 1:12708 CORLEY DR
Practice Address - Street 2:
Practice Address - City:LAMIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1925
Practice Address - Country:US
Practice Address - Phone:562-777-2575
Practice Address - Fax:562-777-2575
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine