Healthcare Provider Details

I. General information

NPI: 1811174428
Provider Name (Legal Business Name): VANI VELKURU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MOWRY AVE SUITE 2 - I
FREMONT CA
94538-1738
US

IV. Provider business mailing address

1999 MOWRY AVE SUITE 2 - I
FREMONT CA
94538-1738
US

V. Phone/Fax

Practice location:
  • Phone: 510-991-7508
  • Fax: 510-991-7503
Mailing address:
  • Phone: 510-991-7508
  • Fax: 510-991-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA96902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: