Individual
MAMATA SIVAGNANAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8110 BIRMINGHAM WAY, BLDG 28, SAN DIEGO, CA 92123-2758
(858) 966-4003
(858) 560-6798
Mailing address
3860 CALLE FORTUNADA, STE #210, SAN DIEGO, CA 92123-4802
(858) 309-6303
(858) 309-6301
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
A86863
CA
Other
Enumeration date
04/24/2007
Last updated
11/01/2011
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