Healthcare Provider Details

I. General information

NPI: 1871551242
Provider Name (Legal Business Name): VEENA H KUPPALLI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14414 LIDDICOAT CIR
LOS ALTOS CA
94022-1851
US

IV. Provider business mailing address

PO BOX 4978
MODESTO CA
95352-4978
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-4575
  • Fax: 209-575-4598
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QH0600X
TaxonomyHistology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JUNE ADAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-575-4575