MEDICARE: ROOPA RAYADURG

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	261QP2000X	Physical Therapy Clinic/Center	PT24408	CA

General Provider Information

NPI Number	:	1659885838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROOPA RAYADURG

Provider Business Mailing Address
First Line	:	242 FERNDALE WAY
Second Line	:
City	:	EMERALD HILLS
State	:	CA
Zip	:	94062-3906
Country	:	US
Telephone Number	:	650-274-8719
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 FERNDALE WAY
Second Line	:
City	:	EMERALD HILLS
State	:	CA
Zip	:	94062-3906
Country	:	US
Telephone Number	:	650-274-8719
Fax Number	:

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

Provider Enumeration Date	:	11/26/2017
Last Update Date	:	11/26/2017

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Directions to “ ROOPA RAYADURG ” Practice Location

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