Healthcare Provider Details

I. General information

NPI: 1104502632
Provider Name (Legal Business Name): VAIISHNAVI RAMESH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13161 JEFFERSON STREET
LE GRAND CA
95333-9766
US

IV. Provider business mailing address

13161 JEFFERSON STREET
LE GRAND CA
95333-9766
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax:
Mailing address:
  • Phone: 209-722-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: