Healthcare Provider Details

I. General information

NPI: 1437379765
Provider Name (Legal Business Name): DECCAN PACIFIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE STE 400
FREMONT CA
94538-1730
US

IV. Provider business mailing address

1860 MOWRY AVE STE 400
FREMONT CA
94538-1730
US

V. Phone/Fax

Practice location:
  • Phone: 510-284-4100
  • Fax: 510-794-9783
Mailing address:
  • Phone: 510-284-4100
  • Fax: 510-794-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA33814
License Number StateCA

VIII. Authorized Official

Name: DR. RAMESH C. KARIPINENI
Title or Position: PRESIDENT
Credential: M. D.
Phone: 510-284-4100