Basic Information
| Provider Information | |||||||||
| NPI: | 1184873762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANDAMUDI | ||||||||
| FirstName: | VENKATA | ||||||||
| MiddleName: | SIVA RAMAKRISHNA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 976 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933020976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365848 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3838 SAN DIMAS ST STE A140 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933011151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616327126 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2008 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 246243 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.