Provider Demographics
NPI:1669775144
Name:DASARATHA R VEMIREDDY MD INC
Entity type:Organization
Organization Name:DASARATHA R VEMIREDDY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DASARATHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VEMIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-826-0477
Mailing Address - Street 1:400 W I ST STE A
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3459
Mailing Address - Country:US
Mailing Address - Phone:209-826-0477
Mailing Address - Fax:209-826-0686
Practice Address - Street 1:400 W I ST STE A
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3459
Practice Address - Country:US
Practice Address - Phone:209-826-0477
Practice Address - Fax:209-826-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32138302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321380OtherPTAN