Individual
ANNAPOORNA MUTHYAPU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3132 W MARCH LN STE 5, STOCKTON, CA 95219-2354
(209) 475-5500
(209) 475-5503
Mailing address
3400 DATA DR, ATTN: CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
134156
CA
Other
Enumeration date
07/20/2012
Last updated
09/18/2018
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