Chivukula, Mamatha

Chivukula, Mamatha is an individual health care provider with primary practice located at 393 E Grand Ave Ste A, South San Francisco CA 94080-6233. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is her primary health care specialty. Chivukula, Mamatha can be contacted via phone (651) 616-2955.

Contact Information

Primary practice address
393 E Grand Ave Ste A South San Francisco CA 94080-6233
Phone: (651) 616-2955
Fax: (650) 737-8920
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X C54789 California
Other Service Providers / Specialist 174400000X MD424156 Pennsylvania
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X C54789 California

Profile Details

NPI number 1750353280
LBN Legal business name Chivukula, Mamatha
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2006
Last updated Mar 28th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750353280 NPPES
Pennsylvania MEDICAID 101241039

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