| Sudhakar Venkata Mallela Md Inc | |
|
6885 Brockton Ave Riverside CA 92506-3811 | |
| (702) 256-3637 | |
| Not Available |
| Full Name | Sudhakar Venkata Mallela Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6885 Brockton Ave, Riverside, California |
| Authorized Official Name and Position | Sudhakar Venkata Mallela (PRESIDENT) |
| Authorized Official Contact | 7022563637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sudhakar Venkata Mallela Md Inc 6885 Brockton Ave Riverside CA 92506-3811 Ph: () - | Sudhakar Venkata Mallela Md Inc 6885 Brockton Ave Riverside CA 92506-3811 Ph: (702) 256-3637 |
| NPI Number | 1518411636 |
|---|---|
| Provider Enumeration Date | 08/05/2016 |
| Last Update Date | 07/17/2018 |
| Medicare PECOS PAC ID | 9830485663 |
|---|---|
| Medicare Enrollment ID | O20160902002087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518411636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Sudhakar V Mallela |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1851498729 PECOS PAC ID: 7517949662 Enrollment ID: I20150115001124 |
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