Individual
BASAVA KUNAMNEMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 N CALIFORNIA ST, STOCKTON, CA 95204
(209) 464-7681
(209) 464-1647
Mailing address
2800 N CALIFORNIA STREET, SUITE 14, STOCKTON, CA 95204
(209) 942-1005
(209) 942-0455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
00C51232D
CA
207RI0011X
Interventional Cardiology Physician
Primary
00C512320
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C51232D
—
CA
01
—
P00473872
RAILROAD MEDICARE
CA
Enumeration date
07/29/2006
Last updated
06/05/2008
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