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Individual

DR. PERAIAH SUDANAGUNTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
400 WEST I ST, LOS BANAS, CA 93635
(209) 710-6331
(209) 827-8224
Mailing address
PO BOX 1408, LOS BANOS, CA 93635-1408
(209) 710-6331
(209) 827-8224

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A24549
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00A245490
CA
Enumeration date
11/14/2006
Last updated
12/21/2007
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