MEDICARE: MR. VACHASPATHI PALAKODETI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A52484	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	WA52484J	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	ZZZ54781Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1649224387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VACHASPATHI PALAKODETI MD

Provider Business Mailing Address
First Line	:	516 WEST ATEN ROAD
Second Line	:	SUITE 2
City	:	IMPERIAL
State	:	CA
Zip	:	92251
Country	:	US
Telephone Number	:	760-355-7730
Fax Number	:	760-355-7731

Provider Business Practice Location Address
First Line	:	516 WEST ATEN ROAD
Second Line	:	SUITE 1
City	:	IMPERIAL
State	:	CA
Zip	:	92251
Country	:	US
Telephone Number	:	760-355-8300
Fax Number	:	760-545-0240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	12/19/2016

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