Healthcare Provider Details

I. General information

NPI: 1508938358
Provider Name (Legal Business Name): INDIRA VEMURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HALE AVE STE I1
MORGAN HILL CA
95037-4348
US

IV. Provider business mailing address

17705 HALE AVE STE: I-1
MORGAN HILL CA
95037-4348
US

V. Phone/Fax

Practice location:
  • Phone: 408-776-9560
  • Fax: 408-778-7857
Mailing address:
  • Phone: 408-776-9560
  • Fax: 408-778-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA80970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: