Provider Demographics
NPI:1528054640
Name:NANDURI, PADMA (MD, FACS)
Entity type:Individual
Prefix:
First Name:PADMA
Middle Name:
Last Name:NANDURI
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 CARROLL CANYON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3756
Mailing Address - Country:US
Mailing Address - Phone:858-450-1010
Mailing Address - Fax:858-450-9451
Practice Address - Street 1:5330 CARROLL CANYON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3756
Practice Address - Country:US
Practice Address - Phone:858-450-1010
Practice Address - Fax:858-450-9451
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2016-12-21
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CAA73131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731310Medicaid
1447215975Medicare UPIN
CAG95242Medicare UPIN
CA00A731310Medicaid