Provider Demographics
NPI:1104322239
Name:KURUVADI, NISHA
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:KURUVADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 MEDICAL CENTER CT STE 203
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6602
Mailing Address - Country:US
Mailing Address - Phone:619-421-3313
Mailing Address - Fax:619-421-3315
Practice Address - Street 1:769 MEDICAL CENTER CT STE 203
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6602
Practice Address - Country:US
Practice Address - Phone:619-421-3313
Practice Address - Fax:619-421-3315
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018606207R00000X
TXS9922207R00000X
CA20100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine