Individual
NITYA MOOTHATHU BHALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
333 CEDAR ST RM TE2, YNHH DEPT OF RADIOLOGY, NEW HAVEN, CT 06510
(203) 785-5253
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-8541
(323) 442-8755
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A154726
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2013
Last updated
07/10/2018
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