Individual
AVANTIKA SHANTANU MUNDKUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(350) 019-2163
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60364
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/13/2020
Last updated
02/07/2022
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