Individual
DR. MAMATHA CHIVUKULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1825 4TH ST, SAN FRANCISCO, CA 94143-2350
(415) 353-1613
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
C54789
CA
174400000X
Specialist
MD424156
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
C54789
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101241039
—
PA
Enumeration date
02/07/2006
Last updated
09/03/2025
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