Healthcare Provider Details

I. General information

NPI: 1801820857
Provider Name (Legal Business Name): BHARATHI S VAYUVEGULA MD PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 S GRAND AVE
GLENDORA CA
91740-5433
US

IV. Provider business mailing address

1624 S GRAND AVE
GLENDORA CA
91740-5433
US

V. Phone/Fax

Practice location:
  • Phone: 626-914-0174
  • Fax: 626-914-2008
Mailing address:
  • Phone: 626-914-0174
  • Fax: 626-914-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BHARATHI S VAYUVEGULA
Title or Position: OWNER
Credential: MD
Phone: 626-914-0174